National Trends in Emergency Room Visits of Dialysis Patients for Adverse Drug Reactions

Abstract

Background: Various medications are cleared by the kidneys, therefore patients with impaired renal function, especially dialysis patients are at risk for adverse drug events (ADEs). There are limited studies on ADEs in maintenance dialysis patients. Methods: We utilized a nationally representative database, the Nationwide Emergency Department Sample, from 2008 to 2013, to compare emergency department (ED) visits for dialysis and propensity matched non-dialysis patients. Log binomial regression was used to calculate relative risk of hospital admission and logistic regression to calculate ORs for in-hospital mortality while adjusting for patient and hospital characteristics. Results: While ED visits for ADEs decreased in both groups, they were over 10-fold higher in dialysis patients than non-dialysis patients (65.8–88.5 per 1,000 patients vs. 4.6–5.4 per 1,000 patients respectively, p < 0.001). The top medication category associated with ED visits for ADEs in dialysis patients is agents primarily affecting blood constituents, which has increased. After propensity matching, patient admission was higher in dialysis patients than non-dialysis patients, (88 vs. 76%, p < 0.001). Dialysis was associated with a 3% increase in risk of admission and 3 times the odds of in-hospital mortality (adjusted OR 3, 95% CI 2.7–2.3.3). Conclusions: ED visits for ADEs are substantially higher in dialysis patients than non-dialysis patients. In dialysis patients, ADEs associated with agents primarily affecting blood constituents are on the rise. ED visits for ADEs in dialysis patients have higher inpatient admissions and in-hospital mortality. Further studies are needed to identify and implement measures aimed at reducing ADEs in dialysis patients.

Iatrogenesis Imperfecta Medicamentosa: Adverse Drug Events in Dialysis Patients are Associated with Higher Resource Utilization and Mortality

“…In this issue of the American Journal of Nephrology , Chan et al [3] publish new insights into the magnitude of serious ADEs affecting patients on dialysis. The study examines 5 years’ worth of data from the Nationwide Emergency Department Sample (NEDS).…”

“…The NEDS database includes information on emergency department visits, hospital admissions, discharges to skilled nursing facilities, and in-hospital mortality, among other data elements [4]. For this study, dialysis status and diagnosis of ADE in the emergency department were identified by specific ICD-9 codes that are captured within the NEDS database [3]. …”

“…The authors used propensity matching to identify a group of control patients who were not on dialysis, but who were as likely as cases to have been on dialysis based on a model that took into account diabetes, hypertension, and heart failure status among other variables [3]. The authors then compared cases of dialysis patients who experienced an ADE with propensity-matched controls to determine any differences in a number of outcomes that relate to resource use and mortality [3].…”

“…The authors then compared cases of dialysis patients who experienced an ADE with propensity-matched controls to determine any differences in a number of outcomes that relate to resource use and mortality [3]. The study results suggest that upward of 1 in every 12 dialysis patients presenting to an emergency department do so as a result of an ADE [3]. This represents a 10-fold increase in the rate of ADE visits as compared with those who are not on dialysis [3].…”

“…The study results suggest that upward of 1 in every 12 dialysis patients presenting to an emergency department do so as a result of an ADE [3]. This represents a 10-fold increase in the rate of ADE visits as compared with those who are not on dialysis [3]. The magnitude of this finding diminished after propensity matching, implying it is at least partially confounded by the effects of unmeasured comorbidity and socioeconomic status [3].…”