People who undergo kidney transplantation are more likely to visit an emergency department post-discharge, said a new study. The frequency of emergency visits is much higher in the first two years after surgery.
The findings published in the Clinical Journal of the American Society of Nephrology (CJASN) 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, (Cleveland Clinic) and his colleagues identified 10,533 kidney transplant recipients from California, New York, and Florida between 2009 and 2012.
- 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.
"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 and Patrick Romano (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.