Study Illustrates Characteristics of Patients With ESRD Using Emergency Departments

A recent study found that US patients with end-stage renal disease (ESRD) using the emergency department (ED) are more likely to be older adults, male, more likely to live in the South, and more likely to have complex medical needs compared with other ED patients without ESRD.

The study sought to define the national characteristics of ED use among patients with ESRD and their proportion of visits from 2014 to 2016. The authors said data that analyzes visits by patients with ESRD proportionally to other ED visits by patients without ESRD is scarce. Understanding more about this issue could possibly allow for ways to reduce ED utilization and improve screening, they said.

The researchers analyzed data about ED visits from 2014 to 2016 provided by the National Hospital Ambulatory Medical Care Survey and sampled adult patients with ESRD going to the ED to quantify annual visits using means of weighted sample variables. The analysis included demographics, ED resource use, clinical characteristics, and disposition of patients with ESRD and compared these to those of patients without ESRD. Logistic regression models were used to estimate the association between these characteristics and ESRD ED visits.

Out of 92,899,685 annual ED visits, nearly 7.8%, or 722,692 (7.78%) represented patients with ESRD.

The analysis found:

• Males were more likely have ESRD than females (adjusted odds ratio [aOR] 1.34; 95% CI,1.09–1.66).
• Non-Hispanic Blacks were 2.55 times more likely to have ESRD (aOR, 2.55; 95% CI, 1.97–3.30) compared with Whites.
• Hispanics were 2.68 times more likely to have ESRD (95% CI, 1.95–3.69) compared with Whites.
• ED patients with ESRD were more likely to be admitted to the hospital (aOR:, 2.70; 95% CI, 2.13–3.41) and intensive care unit (ICU) (aOR, 2.21; 95% CI, 1.45–3.38) than patients without ESRD.
• ED patients with ESRD were more likely to receive blood tests and get radiology tests.
• By Census region, the South led the proportion of visits at 45.6%, followed by the West (21.2%), the Midwest (19.8%), and the Northeast (13.4%).
• Patients who reside in nursing homes were 1.53 times more likely to be patients with ESRD in the ED compared with those in private residences (95% CI, 1.00–2.34).

"The ED plays an important role for ESRD patients that seek urgent care," wrote the authors, noting that the trajectory of ESRD in the United States is expected to grow through 2030.

Understanding more about this issue could help providers aim to improve the efficiency of clinical care and reduce the high rates of hospital admission, which in turn would not only benefit ESRD patients but also benefit hospitals in terms of better resource allocation and better financial allocation.

There were 2 limitations, both having to do with the NHAMCS-ED dataset, the authors said. Patients are coded as either having or not having ESRD, but information such as duration and treatment history are not tracked; that information would help to better predict ESRD status among patients in the ED. Another is that the dataset does not include information about other health issues.

Reference

Wang, N., Pei, J., Fan, H. et al. Emergency department use by patients with end-stage renal disease in the United States. BMC Emerg Med. Published online March 2, 2021. doi: 10.1186/s12873-021-00420-8