Early repeat hospitalization for fluid overload in individuals with cardiovascular disease and risks: a retrospective cohort study

Lim, Cynthia C.; Huang, Dorothy; Huang, Zhihua; Ng, Li Choo; Tan, Ngiap Chuan; Tay, Wei Yi; Bee, Yong Mong; Ang, Andrew; Tan, Chieh Suai

doi:10.1007/s11255-023-03747-2

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…2 Fluid overload was a frequent cause of hospitalizations and readmissions among individuals with kidney disease and other cardiovascular risk conditions. 3 Thus, we hoped to improve community care of these individuals through close follow-up, instituting timely interventions in the early recurrence of fluid overload, improving patient self-management through education, and identifying and addressing psychosocial factors that can lead to hospital readmissions. 4 We adapted and implemented a Hospital to Home transitional care program for patients with kidney disease and hospitalized for fluid overload at Singapore General Hospital.…”

Section: Improving Community Care Of Individuals With Ckdmentioning

confidence: 99%

Improving Community Care of Individuals with CKD

Lim,

Tay

2024

JASN

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Section: Improving Community Care Of Individuals With Ckdmentioning

confidence: 99%

Improving Community Care of Individuals with CKD

Lim,

Tay

2024

JASN

Self Cite

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Hospital Readmissions for Fluid Overload among Individuals with Diabetes and Diabetic Kidney Disease: Risk Factors and Multivariable Prediction Models

Cai,

Huang,

Abdul Kadir

et al. 2024

Nephron

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Aims: Hospital readmissions due to recurrent fluid overload in diabetes and diabetic kidney disease can be avoided with evidence-based interventions. We aimed to identify at-risk patients who can benefit by developing risk prediction models for readmissions for fluid overload in people living with diabetes. Methods: Single-center retrospective cohort study of 1531 adults with diabetes and hospitalized for fluid overload, including congestive heart failure, pulmonary edema and generalized edema, between 2015 and 2017. The multivariable regression models for 30-day and 90-day readmission for fluid overload were compared with the LACE score for discrimination, calibration, sensitivity, specificity and net reclassification index (NRI). Results: Readmissions for fluid overload within 30 days and 90 days occurred in 8.6% and 17.2% of patients with diabetes, and 8.2% and 18.3% of patients with diabetic kidney disease, respectively. After adjusting for demographics, comorbidities, clinical parameters, and medications, a history of alcoholism (HR 3.85, 95% CI 1.41-10.55) and prior hospitalization for fluid overload (HR 2.50, 95% CI 1.26- 4.96) were independently associated with 30-day readmission in patients with diabetic kidney disease, as well as in individuals with diabetes. Additionally, current smoking, absence of hypertension and high-dose intravenous furosemide were also associated with 30-day readmission in individuals with diabetes. Prior hospitalization for fluid overload (HR 2.43, 95% CI 1.50-3.94), cardiovascular disease (HR 1.44, 95% CI 1.03-2.02), eGFR ≤45 ml/min/1.73 m2 (HR 1.39, 95% CI 1.003-1.93) were independently associated with 90-day readmissions in individuals with diabetic kidney disease. Additionally, thiazide at discharge reduced 90-day readmission in diabetic kidney disease while high-dose intravenous furosemide predicted 90-day readmission in diabetes. The clinical and clinico-psychological models for 90-day readmission in individuals with diabetes and diabetic kidney disease had better discrimination and calibration than the LACE score. The NRI for the clinico-psychosocial models to predict 30- and 90-day readmissions in diabetes were 22.4% and 28.9%, respectively. The NRI for the clinico-psychosocial models to predict 30- and 90-day readmissions in diabetic kidney disease were 5.6% and 38.9%, respectively. Conclusion: The risk models can potentially be used to identify patients at-risk of readmission for fluid overload for evidence-based interventions such as patient education or transitional care programs to reduce preventable hospitalizations.

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Recurrent Hospitalizations for Fluid Overload in Diabetes with Kidney Failure Treated with Dialysis

Phang,

Ng,

Kadir

et al. 2024

Cardiorenal Med

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Background & Aims Diabetes Mellitus is the most common cause of end-stage kidney disease (ESKD) in Singapore. ESKD patients have high disease burden and are at increased risk of recurrent hospitalizations, including fluid overload. This study aimed to characterize the risk factors associated with readmissions for fluid overload that will identify high-risk hospitalizations for interventions to reduce readmissions. Methods Retrospective cohort study of all hospitalizations for fluid overload in adults with diabetes and ESKD on dialysis in SingHealth hospitals between 2018 and 2021. Fluid overload was defined by discharge codes for fluid overload, heart failure, pulmonary edema, and generalized edema until 30th December 2022. Multivariable Cox regression analysis using the Prentice, Williams and Peterson Total Time (PWP-TT) model was performed for the outcomes of readmissions for fluid overload within 30 days and 90 days of discharge. Results Among 3234 hospitalizations for fluid overload, readmission for fluid overload within 30-day and 90-day occurred in 585 (18.1%) and 967 (29.9%) hospitalizations, respectively. Ischemic heart disease, peripheral vascular disease and lower hemoglobin level were independently associated with readmissions for fluid overload within 30 and 90 days. Additionally, heart failure, hemodialysis (compared to peritoneal dialysis) and lack of statin at discharge were associated with increased 90-day readmission risk. Conclusion Modifiable (hemoglobin level, statin use) and non-modifiable factors (ischemic heart disease, peripheral vascular disease and heart failure) influenced the risk of readmission for fluid overload. These results may guide risk stratification and inform targeted interventions to reduce avoidable, unplanned readmissions for recurrent fluid overload among individuals with diabetes and ESKD.

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Early repeat hospitalization for fluid overload in individuals with cardiovascular disease and risks: a retrospective cohort study

Cited by 4 publications

References 32 publications

Improving Community Care of Individuals with CKD

Improving Community Care of Individuals with CKD

Hospital Readmissions for Fluid Overload among Individuals with Diabetes and Diabetic Kidney Disease: Risk Factors and Multivariable Prediction Models

Recurrent Hospitalizations for Fluid Overload in Diabetes with Kidney Failure Treated with Dialysis

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