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Abstract: SA-PO322

Rethinking Potentially Preventable Emergency Department Use Among People Receiving Dialysis: A Population-Based Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Elliott, Meghan J., University of Calgary, Calgary, Alberta, Canada
  • MacRae, Jennifer M., University of Calgary, Calgary, Alberta, Canada
  • Lang, Eddy, University of Calgary, Calgary, Alberta, Canada
  • Mcrae, Andrew, University of Calgary, Calgary, Alberta, Canada
  • Donald, Maoliosa, University of Calgary, Calgary, Alberta, Canada
  • Hemmelgarn, Brenda, University of Alberta, Edmonton, Alberta, Canada
  • Ronksley, Paul E., University of Calgary, Calgary, Alberta, Canada
Background

People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold higher than the general population. Little is known about the clinical and socio-demographic factors that contribute to potentially preventable ED use.

Methods

In this retrospective cohort study, we used administrative data to identify adults receiving maintenance dialysis for >3 months between April 1, 2010 and March 31, 2019 in Alberta, Canada. We captured clinical characteristics and rates of ED use and followed patients until death or end of study (March 31, 2019). We determined age- and sex-adjusted rates of all-cause and potentially preventable ED use (defined by kidney disease-specific ambulatory care sensitive conditions: hyperkalemia, heart failure, volume overload, and malignant hypertension). We examined the association between clinical and socio-demographic factors and rates of potentially preventable ED encounters using multivariable negative binomial regression models.

Results

Our cohort included 4,402 people with kidney failure (2,781 hemodialysis; 1,621 peritoneal dialysis) followed for a mean of 2.8 years. 3,440 patients had 29,927 all-cause ED encounters (adjusted rate 3,065/1,000 person years). Of these, 654 patients had 1,153 potentially preventable ED encounters (adjusted rate 107/1,000 person years). Potentially preventable ED encounters were more likely in those who were socioeconomically disadvantaged, had higher comorbidity burden, and had longer dialysis vintage. Multivariable regression identified that preventable ED use was significantly higher for younger adults (age <45 years; IRR: 1.37 [95% CI 1.08-1.75]) and those with chronic pain (IRR: 1.33 [95% CI 1.06-1.66]), greatest material deprivation (IRR: 1.39 [95% CI 1.02-1.90]), and a history of hyperkalemia (IRR: 1.34 [95% CI 1.11-1.63]).

Conclusion

We identified that potentially preventable ED use among people receiving dialysis is related to both socio-demographic and clinical factors. Our findings underscore the need to implement and test strategies that address social determinants of health to avert potentially preventable ED use in this population.