Most Kidney Transplant Recipients Visit the Emergency Department After Discharge

Certain characteristics may increase patients’ risk for needing emergency care

Highlights
• Risk factors for emergency department visits included younger age, females, black and Hispanic race/ethnicity, public insurance, depression, diabetes, peripheral vascular disease, and use of emergency departments prior to transplantation.

Nearly 17,000 patients receive kidney transplants each year in the United States.

More than half of kidney transplant recipients will visit an emergency department in the first 2 years after transplantation, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings indicate that efforts are needed to coordinate care for this vulnerable patient population.

Little information is available on the incidence and risk factors associated with emergency department visits among kidney transplant recipients. In their efforts to investigate the issue, Jesse Schold, PhD (Cleveland Clinic) and his colleagues identified 10,533 kidney transplant recipients from California, New York, and Florida between 2009 and 2012.

Among the major findings:
• The cumulative incidence of emergency department visits at 1, 12, and 24 months was 12%, 40% and 57%, respectively, with a median time of 19 months.
• 48% of emergency department visits led to hospital admission.
• Risk factors for emergency department visits included younger age, females, black and Hispanic race/ethnicity, public insurance, depression, diabetes, peripheral vascular disease, and use of emergency departments prior to transplantation.
• There was wide variation in visits by individual transplant center.

“These data provide fundamental baseline information concerning the scope and factors of emergency department visits and potential interventions and target populations for future study,” said Dr. Schold. “It is crucially important that emergency department clinicians are cognizant of the specific issues pertinent to transplant recipients given unique medical issues. Moving forward, tailored interventions, particularly to patients and institutions with high rates of emergency department visits following discharge may be important.”

In an accompanying editorial, Lorien Dalrymple, MD, MPH, and Patrick Romano, MD, MPH (University of California at Davis) note that the study “is important as it extends prior findings that were limited to single centers and addresses an understudied topic.” They add that the findings suggest numerous areas for future research—for example, reasons for kidney recipients’ hospital admissions, potential disparities in access to care, and rates of repeat emergency department visits.

Study co-authors include Nissreen Elfadawy, MD, Laura Buccini, DrPH, MS, David Goldfarb, MD, Stuart Flechner, MD, Michael Phelan, MD, and Emilio Poggio, MD.

Disclosures: The authors reported no financial disclosures.

The article, entitled “Emergency Department Visits Following Kidney Transplantation,” will appear online at http://cjasn.asnjournals.org/ on March 24, 2016, doi: 10.2215/CJN.07950715.

The editorial, entitled “Emergency Department Visits by Kidney Transplant Recipients,” will appear online at http://cjasn.asnjournals.org/ on March 24, 2016.
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