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Original Investigation

The Impact of COVID-19 on Post-Discharge Outcomes for Dialysis Patients in the United States: Evidence from Medicare Claims Data

Wenbo Wu, Garrett W. Gremel, Kevin He, Joseph M. Messana, Ananda Sen, Jonathan H. Segal, Claudia Dahlerus, Richard A. Hirth, Jian Kang, Karen Wisniewski, Tammie Nahra, Robin Padilla, Lan Tong, Haoyu Gu, Xi Wang, Megan Slowey, Ashley Eckard, Xuemei Ding, Lisa Borowicz, Juan Du, Brandon Frye and John D. Kalbfleisch
Kidney360 April 2022, 10.34067/KID.0000242022; DOI: https://doi.org/10.34067/KID.0000242022
Wenbo Wu
1Department of Biostatistics, University of Michigan, United States
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Garrett W. Gremel
2University of Michigan, United States
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Kevin He
2University of Michigan, United States
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Joseph M. Messana
3Health Management and Policy, University of Michigan School of Public Health, United States of America
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Ananda Sen
4Family Medicine, University of Michigan, United States
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Jonathan H. Segal
2University of Michigan, United States
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Claudia Dahlerus
5Internal Medicine, University of Michigan, United States
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Richard A. Hirth
6Dept Health Management and Policy, U Michigan, United States
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Jian Kang
2University of Michigan, United States
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Karen Wisniewski
2University of Michigan, United States
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Tammie Nahra
7University of Mcihigan, United States
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Robin Padilla
8Biostatistics, University of Michigan, United States
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Lan Tong
2University of Michigan, United States
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Haoyu Gu
2University of Michigan, United States
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Xi Wang
2University of Michigan, United States
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Megan Slowey
9Kidney Epidemiology & Cost Center, University of Michigan, United States
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Ashley Eckard
2University of Michigan, United States
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Xuemei Ding
2University of Michigan, United States
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Lisa Borowicz
2University of Michigan, United States
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Juan Du
2University of Michigan, United States
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Brandon Frye
10UM-KECC, University of Michigan, United States
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John D. Kalbfleisch
11Biostatistics, University of Michigan-Ann Arbor, United States
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  • For correspondence: jdkalbfl@umich.edu
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Key Points

  • We studied the impact of COVID-19 on the 30-day post-discharge outcomes of dialysis patients with end-stage kidney disease.

  • During the first post-discharge week, dialysis patients hospitalized with COVID-19 were more likely to experience readmission and death.

  • After the first week, there was no marked difference in the risks of readmission and death between patients with COVID-19 and those without.

Abstract

Background: Recent investigations have shown that on average patients hospitalized with coronavirus disease 2019 (COVID-19) have a poorer post-discharge prognosis than those hospitalized without COVID-19, but this impact remains unclear among dialysis patients with end-stage kidney disease (ESKD). Methods: Leveraging a national ESKD patient claims database administered by the United States Centers for Medicare & Medicaid Services, we conducted a retrospective cohort study, which characterized the effects of in-hospital COVID-19 on all-cause unplanned readmission and death within 30 days of discharge for dialysis patients. Included in this study were 436,745 live acute-care hospital discharges of 222,154 Medicare beneficiaries on dialysis from 7,871 Medicare-certified dialysis facilities between January 1, 2020 and October 31, 2020. Adjusting for patient demographics, clinical characteristics, and prevalent comorbidities, we fit facility-stratified Cox cause-specific hazard models with two interval-specific (1-7 and 8-30 days after hospital discharge) effects of in-hospital COVID-19 as well as effects of pre-hospitalization COVID-19. Results: The hazard ratios due to in-hospital COVID-19 over the first 7 days following discharge were 1.59 for readmission and 1.53 for death, both with P<0.001. For the remaining 23 days, the hazard ratios were 0.92 and 0.96 with P<0.001 and P=0.50, respectively. Effects of pre-hospitalization COVID-19 were mostly nonsignificant. Conclusions: In-hospital COVID-19 had an adverse effect on both post-discharge readmission and death over the first week. With the surviving COVID-19 patients substantially selected from those hospitalized, in-hospital COVID-19 was associated with lower rates of readmission and death starting from the second week.

  • COVID-19
  • United States
  • Patient Discharge
  • Aftercare
  • SARS-CoV-2
  • Received January 7, 2022.
  • Revision received April 15, 2022.
  • Accepted April 15, 2022.
  • Copyright © 2022 American Society of Nephrology
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Kidney360: 3 (4)
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28 Apr 2022
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COVID-19 Post-Discharge Outcomes
Wenbo Wu, Garrett W. Gremel, Kevin He, Joseph M. Messana, Ananda Sen, Jonathan H. Segal, Claudia Dahlerus, Richard A. Hirth, Jian Kang, Karen Wisniewski, Tammie Nahra, Robin Padilla, Lan Tong, Haoyu Gu, Xi Wang, Megan Slowey, Ashley Eckard, Xuemei Ding, Lisa Borowicz, Juan Du, Brandon Frye, John D. Kalbfleisch
Kidney360 Apr 2022, 10.34067/KID.0000242022; DOI: 10.34067/KID.0000242022

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COVID-19 Post-Discharge Outcomes
Wenbo Wu, Garrett W. Gremel, Kevin He, Joseph M. Messana, Ananda Sen, Jonathan H. Segal, Claudia Dahlerus, Richard A. Hirth, Jian Kang, Karen Wisniewski, Tammie Nahra, Robin Padilla, Lan Tong, Haoyu Gu, Xi Wang, Megan Slowey, Ashley Eckard, Xuemei Ding, Lisa Borowicz, Juan Du, Brandon Frye, John D. Kalbfleisch
Kidney360 Apr 2022, 10.34067/KID.0000242022; DOI: 10.34067/KID.0000242022
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Keywords

  • COVID-19
  • United States
  • Patient Discharge
  • Aftercare
  • SARS-CoV-2

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