Abstract: FR-PO786
B-Line Score Is Predictive of Repeat Acute Care Utilization in Hemodialysis Patients
Session Information
- Dialysis: Hospitalization and Mortality
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Reisinger, Nathaniel C., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Brown, Jordan, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Mazumder, Proma, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Yarmey, Erik, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Shofer, Frances, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Dean, Anthony J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Panebianco, Nova, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background
ESRD is burdensome both for patients and healthcare systems because of high acute care utilization. Hemodialysis (HD) patients present to an emergency department (ED) an average of 3 times per year and are hospitalized an average of twice per year with readmission rates of 30%. Readmissions are particularly taxing on hospitals as they are not reimbursed by Medicare. Cardiovascular disease, due in large part to visits for fluid overload (FO), drives these high rates of acute care utilization. The standard of care for assessment of FO remains physical exam despite its poor accuracy. 28-point B-line score (BLS) has emerged as a quantitative marker of FO, outperforming the physical exam. The goal of this study was to determine if BLS is predictive of hospital readmissions or ED revisits.
Methods
A convenience sample of patients with ESRD presenting to a large urban tertiary care ED was enrolled consecutively. Patients were excluded if they were not chronically on HD or were unable to consent. BLS was obtained after enrollment, prior to their first HD session at our center. The patients were followed for 30 days to determine the rate of readmissions and 60 days to determine the rate of ED revisits. Presence of FO was determined by the treating nephrologist or on chart review. Visits for FO were determined by discharge diagnosis.
Results
Of 101 patients enrolled, median age was 60, 51% were male, 84% identified as Black or African American. Comorbidities included 65% diabetic, 27% coronary artery disease, 33% airways disease, 40% systolic heart failure, 75% diastolic heart failure. Median dialysis vintage was 33 months. Access type was 54% arteriovenous fistula, 29% graft, and 17% catheter. ESRD vintage was 33 months. Residual renal function was minimal. 62% of patients had FO on arrival and 27% of visits were for FO. 45% of patients had an ED revisit within 60 days. Median BLS for patients with a 60-day ED revisit was significantly higher than those without (64 vs 29, p=0.001). Median BLS for patients with a 30-day readmission was also higher (57 vs 32, p=0.12).
Conclusion
BLS for patients with a 60-day ED revisit or 30-day readmission was higher than patients without revisits or readmissions. BLS is a useful metric in the ED for determining whether patients with ESRD on HD are likely to have repeat visits.