• Jeffrey Perl, Eric McArthur, Chaim Bell, Amit X Garg, Joanne M Bargman, Christopher T Chan, Shai Harel, Lihua Li, Arsh K Jain, Danielle M Nash, and Ziv Harel.
• Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: jeff.perl@utoronto.ca.
• Am. J. Kidney Dis. 2017 Jul 1; 70 (1): 11-20.

BackgroundReadmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readmission following discharge.Study DesignPopulation-based retrospective-cohort observational study.Settings & ParticipantsPatients treated with maintenance dialysis who were discharged following an acute-care hospitalization during January 1, 2003, to December 31, 2013, across 164 acute-care hospitals in Ontario, Canada. For those with multiple hospitalizations, we randomly selected a single hospitalization as the index hospitalization.PredictorDialysis modality PD or in-center HD. Propensity scores were used to match each patient on PD therapy to 2 patients on in-center HD therapy to ensure that baseline indicators of health were similar between the 2 groups.OutcomeAll-cause 30-day readmission following the index hospital discharge.Results28,026 dialysis patients were included in the study. 4,013 PD patients were matched to 8,026 in-center HD patients. Among the matched cohort, 30-day readmission rates were 7.1 (95% CI, 6.6-7.6) per 1,000 person-days for patients on PD therapy and 6.0 (95% CI, 5.7-6.3) per 1,000 person-days for patients on in-center HD therapy. The risk for a 30-day readmission among patients on PD therapy was higher compared with those on in-center HD therapy (adjusted HR, 1.19; 95% CI, 1.08-1.31). The primary results were consistent across several key prespecified subgroups.LimitationsLack of information for the frequency of nephrology physician encounters following discharge from the hospital in both the PD and in-center HD cohorts. Limited validation of International Classification of Diseases, Tenth Revision codes.ConclusionsThe risk for 30-day readmission is higher for patients on home-based PD compared to in-center HD therapy. Interventions to improve transitions in care between the inpatient and outpatient settings are needed, particularly for patients on PD therapy.Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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