Early rehospitalization after initial chronic kidney disease educational hospitalization relates with a multidisciplinary medical team

Abstract

Background

It is well-documented that chronic kidney disease (CKD) often results in end-stage renal failure and puts patients at extremely high risk for developing cardiovascular disease. Educational hospitalization at medical institutions in Japan is important for patients with CKD because it facilitates treatment in earlier stages of CKD when subjective symptoms are not apparent. However, some patients who have achieved their educational targets tend to have poor compliance at home after discharge from the hospital, resulting in rehospitalization shortly. In this study, we examined the factors for early rehospitalization of patients after initial CKD educational hospitalization compared with non-rehospitalized patients.

Methods

One hundred thirty-seven patients after discharge from CKD educational hospitalization in Japan between March 2011 and December 2012 were included in the analyses. The subjects were classified into two groups: the early rehospitalization group and control group. We adjusted for confounding variables and performed multiple logistic regression analysis with the presence or absence of early rehospitalization as a dependent variable to investigate the association of early rehospitalization with patient background features, laboratory data, vital signs, instruction-related items, and home environment.

Results

Study subjects included 22 patients in the early hospitalization group and 115 patients in control group. Multivariable analysis for early rehospitalization indicated that insufficient instruction by physician, pharmacist, and dietitians was independent explanatory variable. Analyzing by Kaplan–Meier method, the probability of non-rehospitalization in the instruction group was significantly higher than that in the non-instruction group. Therefore, we believe it is necessary to involve a competent, multidisciplinary medical team (consisting of physicians, pharmacists, and dietitians) in addressing the early rehospitalization issue in patients with CKD.

Conclusion

These findings confirm the importance of care by a multidisciplinary medical team in patients with CKD. Therefore, we suggest that care by a multidisciplinary medical team reduces the increase of early rehospitalization in patients with CKD.