Abstract: SA-PO970
Predictors of Need for Recurrent Emergency Medical Service Transport to an Emergency Department After Dialysis Initiation
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Tennankore, Karthik K., Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada
- Bartolacci, John Enrico, Dalhousie University, Halifax, Nova Scotia, Canada
- Goldstein, Judah, Dalhousie University, Halifax, Nova Scotia, Canada
- Clark, David, Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada
- Swain, Janel M., Emergency Health Services Nova Scotia, Dartmouth, Nova Scotia, Canada
- Vinson, Amanda Jean, Dalhousie University/NS Health Authority, Halifax, Nova Scotia, Canada
Background
Dialysis patients are frequently transported to the emergency department (ED) by Emergency Medical Services (EMS) due to acute illness. However, little is known about the predictors of recurrent transport to the ED (EMS-ED), based on characteristics at the time of dialysis initiation.
Methods
We analyzed a cohort of adult (≥18 years) patients affiliated with a large quaternary care center who initiated chronic dialysis from 2009-2013 (last follow-up: 2015). Data on patient characteristics at the time of dialysis initiation was linked to regional EMS data. Candidate predictors of recurrent EMS-ED transport included comorbid conditions, dialysis characteristics and frailty severity (using the first version of the clinical frailty scale score; CFS). Time to recurrent EMS-ED was analyzed using the Anderson-Gill counting approach, accounting for competing risks of death and transplant.
Results
A total of 455 patients were included in the study, 246 (54%) had one or more EMS-ED events, 90 (20%) never required an EMS-ED at last follow-up, and 15% and 12% experienced transplant or death as their first event, respectively. The mean age of the cohort was 62 ± 15 years, 89% were Caucasian, and 34% were of female sex. Patients were highly comorbid (48% had diabetes, 30% had coronary artery disease and 17% had peripheral vascular disease) and 97/381 with available data on frailty severity had a CFS score of ≥5 corresponding to “mildly to severely frail”. After adjustment, increasing CFS score (subdistribution hazard ratio (SHR) 2.41, 95% confidence interval (CI) 1.48-3.95 for CFS 3-4; and SHR 3.05, 95% CI 1.73-5.38 for CFS ≥5 relative to a CFS 1-2), rheumatologic disease (SHR 1.54, 95% CI 1.04-2.29), end-stage renal disease (ESRD) secondary to polycystic kidney disease (SHR 2.00, 95% CI 1.11-3.59 relative to glomerulonephritis as cause of ESRD) and > 3 months of nephrology follow-up prior to dialysis initiation (SHR 1.52, 95% CI 1.10-2.08) predicted recurrent EMS-ED.
Conclusion
Patients are at a high risk of EMS-ED after dialysis initiation. Frailty severity (at the time of dialysis initiation) is the strongest predictor of recurrent EMS-ED and this may be important to guide informed decision making and resource planning for dialysis patients.