Association between the Charlson Comorbidity Index and the risk of 30-day unplanned readmission in patients receiving maintenance dialysis

Abstract

Background: Patients receiving maintenance hemodialysis (HD) and peritoneal dialysis (PD) are frequently hospitalized. Reducing unplanned 30-day hospital readmissions is a key priority for improving the quality of health care. The purpose of this study was to assess the association between the Charlson Comorbidity Index (CCI), which has been used to evaluate multi-comorbidities status, and 30-day readmission in patients on HD and PD therapy. Methods: The Hospital Quality Monitoring System (HQMS), a national administrative database for hospitalized patients in China was used to extract dialysis patients admitted from January 2013 to December 2015. The outcome was the unplanned readmission following the hospital discharge within 30 days. For patients with multiple hospitalizations, a single hospitalization was randomly selected as the index hospitalization. A cause-specific Cox proportional hazard model was utilized to assess the association of CCI with readmission within 30 days. Results: Of the 124,721 patients included in the study, 19,893 patients (16.0%) were identified as experiencing unplanned readmissions within 30 days. Compared with patients without comorbidity (CCI = 2, scored for dialysis), the risk of 30-day readmission increased with elevated CCI score. The hazards ratio (HR) for those with CCI 3-4, 5-6 and > 6 was 1.01 (95% confidence interval [CI] 0.98-1.05), 1.09 (95% CI 1.05-1.14), and 1.14 (95% CI 1.09-1.20), respectively. Conclusions: Our study indicated that CCI was independently associated with the risk of 30-day readmission for patients receiving dialysis including HD and PD, and could be used for risk-stratification.