Associations among race, residential segregation, community income, and emergency department use by adults with end‐stage renal disease

2019 ◽  
Vol 36 (5) ◽  
pp. 645-652 ◽  
Author(s):  
Charlotte Thomas‐Hawkins ◽  
Linda Flynn ◽  
Peijia Zha ◽  
Beth Savage
Keyword(s):  
Emergency Department ◽  
Renal Disease ◽  
Residential Segregation ◽  
End Stage Renal Disease ◽  
Emergency Department Use ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Emergency Department Use and Hospital Admissions Among Patients With End-Stage Renal Disease in the United States

2016 ◽  
Vol 176 (10) ◽  
pp. 1563 ◽  
Author(s):  
Brendan P. Lovasik ◽  
Rebecca Zhang ◽  
Jason M. Hockenberry ◽  
Justin D. Schrager ◽  
Stephen O. Pastan ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Hospital Admissions ◽  
The United States ◽  
Emergency Department Use ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Effects of Early Frequent Nephrology Care on Emergency Department Visits among Patients with End-stage Renal Disease

2019 ◽  
Vol 16 (7) ◽  
pp. 1158
Author(s):  
Yun-Yi Chen ◽  
Likwang Chen ◽  
Jenq-Wen Huang ◽  
Ju-Yeh Yang
Keyword(s):  
Emergency Department ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Lower Risk ◽  
Early Referral ◽  
Dialysis Treatment ◽  
Nephrology Care ◽  
Stage Renal Disease ◽  
End Stage ◽  
Late Referral

In this retrospective cohort study, we examined the association between predialysis nephrology care status and emergency department (ED) events among patients with end-stage renal disease. Data pertaining to 76,702 patients who began dialysis treatment between 1999 and 2010 were obtained from the National Health Insurance Research Database of Taiwan (NHIRD). The patients were divided into three groups based on the timing of the first nephrology care visit prior to the initiation of maintenance dialysis, and the frequency of nephrologist visits (i.e., early referral/frequent consultation, early referral/infrequent consultation, late referral). At 1-year post-dialysis initiation, a large number of the patients had experienced at least one all-cause ED visit (58%), infection-related ED visit (17%), or potentially avoidable ED visit (7%). Cox proportional hazard models revealed that patients who received early frequent care faced an 8% lower risk of all-cause ED visit (HR: 0.92; 95% CI: 0.90–0.94), a 24% lower risk of infection-related ED visit (HR: 0.76; 95% CI: 0.73–0.79), and a 24% lower risk of avoidable ED visit (HR: 0.76; 95% CI: 0.71–0.81), compared with patients in the late referral group. With regard to the patients undergoing early infrequent consultations, the only marginally significant association was for infection-related ED visits. Recurrent event analysis revealed generally consistent results. Overall, these findings indicate that continuous nephrology care from early in the predialysis period could reduce the risk of ED utilization in the first year of dialysis treatment.

scholarly journals Severe Hypoglycemia as a Predictor of End-Stage Renal Disease in Type 2 Diabetes: A National Cohort Study

2019 ◽  
Vol 16 (5) ◽  
pp. 681
Author(s):  
Yu-Li Lee ◽  
Shih-Jung Yen ◽  
Shyi-Jang Shin ◽  
Yi-Chi Huang ◽  
Jiun He ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Emergency Department ◽  
Renal Disease ◽  
Emergency Department Visit ◽  
End Stage Renal Disease ◽  
Severe Hypoglycemia ◽  
Stage Renal Disease ◽  
End Stage ◽  
Diabetes Patients

Aims: This study investigated whether there is a link between severe hypoglycemia and progression into end-stage renal disease (ESRD) in patients with type 2 diabetes. Methods: Tapping into Taiwan’s Health Insurance Research Database, we identified all type 2 diabetes patients between 1996 and 2013 and identified those diagnosed with a severe hypoglycemia episode during an emergency department visit and those who were not. Controls were then matched 1:1 for age, sex, index year, and medication. Results: We identified 468,421 type 2 diabetes patients diagnosed as having severe hypoglycemia in an emergency department visit. Compared with controls, these patients with SH had a higher risk of all-cause mortality (Hazard Ratio (HR), 1.76; 95% confidence interval, 1.61–1.94) and progressed into ESRD within a shorter period of time. Results were similar after controlling for competing risk. Conclusion: Severe hypoglycemia is significantly associated with worsening renal dysfunction in patients with type 2 diabetes and hastened progression into ESRD.

scholarly journals Do Bacteremic Patients with End-Stage Renal Disease Have a Fever When Presenting to The Emergency Department? A Paired, Retrospective Cohort Study.

2019 ◽  
Author(s):  
Leonard Mermel ◽  
Sarah L. Weatherall ◽  
Alison B. Chambers
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
End Stage Renal Disease ◽  
Emergency Departments ◽  
Retrospective Cohort ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Fever is a common symptom when patients present to Emergency Departments. It is unclear if the febrile response of bacteremic hemodialysis-dependent patients differs from bacteremic patients not receiving hemodialysis. The objective of this study was to compare Emergency Departments triage temperatures of patients with and without hemodialysis-dependent end-stage rental disease who have Staphylococcus aureus bacteremia and determine the incidence of afebrile S. aureus bacteremia.Methods Paired, retrospective cohort study of 37 patients with and 37 patients without hemodialysis hospitalized with Methicillin-resistant or Methicillin-susceptible S. aureus bacteremia. Emergency Department triage temperatures were reviewed for all patients, as were potential confounding variables.Results 54% (95% CI, 38-70%) and 82% (95% CI 65-91%) of hemodialysis and non-hemodialysis patients did not have a detectable fever (<100.4°F) at triage. Triage temperatures were 100.5°F (95% CI 99.9-101.2°F) and 99.0°F (95% CI 98.4-99.6°F) in the hemodialysis and non-hemodialysis cohorts, respectively (p<0.001). Triage temperature in patients with and without diabetes mellitus was 99.2°F (95% CI 98.4-99.9°F) and 100.4°F (95% CI 99.7-101.0°F), respectively (p=0.03). We were unable to detect a significant effect of diabetes mellitus and other potential confounding variables on differences in temperature between the hemodialysis and non-hemodialysis cohorts (all interactions p > 0.19).Conclusions Hemodialysis-dependent patients with S. aureus bacteremia had significantly higher temperatures than non- hemodialysis-dependent end stage renal disease patients but more than half of patients were without detectable fever at triage, possibly reflecting use of insensitive methods for measuring temperature. Absence of fever at presentation to the Emergency Department should not delay blood culture acquisition in patients who are at increased risk of S. aureus bacteremia.

scholarly journals Factors Associated with Blood Culture Contamination in the Emergency Department: Critical Illness, End-Stage Renal Disease, and Old Age

PLoS ONE ◽  
2015 ◽  
Vol 10 (10) ◽  
pp. e0137653 ◽  
Author(s):  
Chih-Jan Chang ◽  
Chi-Jung Wu ◽  
Hsiang-Chin Hsu ◽  
Chiu-Hui Wu ◽  
Fang-Ying Shih ◽  
...  
Keyword(s):  
Emergency Department ◽  
Critical Illness ◽  
Blood Culture ◽  
Renal Disease ◽  
Old Age ◽  
End Stage Renal Disease ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Do Bacteremic Patients with End-Stage Renal Disease Have a Fever When Presenting to The Emergency Department? A Paired, Retrospective Cohort Study.

2019 ◽  
Author(s):  
Sarah L. Weatherall ◽  
Alison B. Chambers ◽  
Leonard Mermel
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
End Stage Renal Disease ◽  
Retrospective Cohort ◽  
Confounding Variables ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Fever is a common symptom when patients present to Emergency Departments. It is unclear if the febrile response of bacteremic hemodialysis-dependent patients differs from bacteremic patients not receiving hemodialysis. The objective of this study was to compare Emergency Departments triage temperatures of patients with and without hemodialysis-dependent end-stage rental disease who have Staphylococcus aureus bacteremia and determine the incidence of afebrile S. aureus bacteremia. Methods: Paired, retrospective cohort study of 37 patients with and 37 patients without hemodialysis hospitalized with Methicillin-resistant or Methicillin-susceptible S. aureus bacteremia. Emergency Department triage temperatures were reviewed for all patients, as were potential confounding variables. Results: 54% (95% CI, 38-70%) and 82% (95% CI 65-91%) of hemodialysis and non-hemodialysis patients did not have a detectable fever (<100.4°F) at triage. Triage temperatures were 100.5°F (95% CI 99.9-101.2°F) and 99.0°F (95% CI 98.4-99.6°F) in the hemodialysis and non-hemodialysis cohorts, respectively (p<0.001). Triage temperature in patients with and without diabetes mellitus was 99.2°F (95% CI 98.4-99.9°F) and 100.4°F (95% CI 99.7-101.0°F), respectively (p=0.03). We were unable to detect a significant effect of diabetes mellitus and other potential confounding variables on differences in temperature between the hemodialysis and non-hemodialysis cohorts (all interactions p > 0.19). Conclusions: Hemodialysis-dependent patients with S. aureus bacteremia had significantly higher temperatures than non- hemodialysis-dependent end stage renal disease patients but more than half of patients were without detectable fever at triage, possibly reflecting use of insensitive methods for measuring temperature. Absence of fever at presentation to the Emergency Department should not delay blood culture acquisition in patients who are at increased risk of S. aureus bacteremia.

scholarly journals Do Bacteremic patients with end-stage renal disease have a fever when presenting to the emergency department? A paired, retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah L. Weatherall ◽  
Alison B. Chambers ◽  
Leonard A. Mermel
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Cohort Study ◽  
Renal Disease ◽  
Retrospective Cohort Study ◽  
End Stage Renal Disease ◽  
Retrospective Cohort ◽  
Confounding Variables ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Fever is a common symptom when patients present to Emergency Departments. It is unclear if the febrile response of bacteremic hemodialysis-dependent patients differs from bacteremic patients not receiving hemodialysis. The objective of this study was to compare Emergency Departments triage temperatures of patients with and without hemodialysis-dependent end-stage rental disease who have Staphylococcus aureus bacteremia and determine the incidence of afebrile S. aureus bacteremia. Methods Paired, retrospective cohort study of 37 patients with and 37 patients without hemodialysis hospitalized with Methicillin-resistant or Methicillin-susceptible S. aureus bacteremia. Emergency Department triage temperatures were reviewed for all patients, as were potential confounding variables. Results 54% (95% CI, 38–70%) and 82% (95% CI 65–91%) of hemodialysis and non-hemodialysis patients did not have a detectable fever (<100.4 °F) at triage. Triage temperatures were 100.5 °F (95% CI 99.9–101.2 °F) and 99.0 °F (95% CI 98.4–99.6 °F) in the hemodialysis and non-hemodialysis cohorts, respectively (p < 0.001). Triage temperature in patients with and without diabetes mellitus was 99.2 °F (95% CI 98.4–99.9 °F) and 100.4 °F (95% CI 99.7–101.0 °F), respectively (p = 0.03). We were unable to detect a significant effect of diabetes mellitus and other potential confounding variables on differences in temperature between the hemodialysis and non-hemodialysis cohorts (all interactions p > 0.19). Conclusions Hemodialysis-dependent patients with S. aureus bacteremia had significantly higher temperatures than non- hemodialysis-dependent end stage renal disease patients but more than half of patients were without detectable fever at triage, possibly reflecting use of insensitive methods for measuring temperature. Absence of fever at presentation to the Emergency Department should not delay blood culture acquisition in patients who are at increased risk of S. aureus bacteremia.

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