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Kidney Week

Abstract: SA-PO621

A Vulnerable Population: Case Series Examining Involuntarily Discharged Hemodialysis Patients in an Urban, Predominantly Black US Population

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Nnadike, Zikora U., Emory University School of Medicine, Atlanta, Georgia, United States
  • Shah, Anjuli, Emory University School of Medicine, Atlanta, Georgia, United States
  • Gray, Carol A., Emory Healthcare, Atlanta, Georgia, United States
  • Cobb, Loren Carter, Meharry Medical College, Nashville, Tennessee, United States
  • O'Donnell, Christopher M., Emory University School of Medicine, Atlanta, Georgia, United States
  • Navarrete, Jose E., Emory University School of Medicine, Atlanta, Georgia, United States
  • Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
Background

An overlooked population is the number of insurable involuntarily discharged hemodialysis (HD) patients receiving maintenance HD. Presented is a case series examining involuntarily discharged HD patients receiving maintenance HD in inpatient settings in an urban US population.

Methods

Retrospective chart review of potential involuntarily discharged HD patients from 2020 – 2023 observed at Emory Hospitals and Grady Memorial Hospital. Studied were insurable end stage kidney disease (ESKD) patients who started HD as inpatient and were seen for inpatient dialysis >60 days and patients involuntarily discharged from a HD center.

Results

Among the 25 ESKD patients – all Black race and 68% male. 13 discharged for noncompliance, 8 discharged for disruptive behavior, 3 for insurance reasons, and 1 undetermined. HD vascular access – permcath (n=13), arteriovenous graft (n=4), and arteriovenous fistula (n=8). Observed hospitalizations for HD ranged from 3 to 298. The 3 patients discharged for insurance reasons included 2 patients initiated on HD as an inpatient and declared ESKD and received HD as an inpatient >60 days. Suspected noncompliance prevented them from being accepted despite being insurance eligible. 16 patients received a second chance outpatient HD center, and 1 was discharged from the second chance HD unit.

Conclusion

This case series brings attention to a vulnerable nephrology population. Most of the patients were discharged for subjective reasons like noncompliance and the impact of biases are hard to determine, but the patients being 100% Black is remarkable. The high level of success with second chance HD center placement demonstrates a need for interventions. More data is needed to examine geographic variances, economic impact, and the psychological toll emergency-only inpatient HD is having on these patients.