Emergency department use by patients with end-stage renal disease in the United States

• Published in: BMC emergency medicine Vol. 21; no. 1; p. 25
• Main Authors: Wang, Ningyuan, Pei, Jiao, Fan, Hui, Ali, Yaseen, Prushinskaya, Anna, Zhao, Jian, Zhang, Xingyu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-03-2021; BioMed Central; BMC
• Subjects: Age; Blood; Blood pressure; Blood tests; Chronic kidney failure; Comparative analysis; Demographics; Demography; Diabetes; Emergencies; Emergency medical care; Emergency Medical Services; Emergency medicine; Emergency service; Emergency Service, Hospital; End-stage renal disease; Female; Health Care Surveys; Health surveys; Hospitals; Humans; Hypertension; Kidney diseases; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Male; Medical care; Medical examination; Medical research; Medicare; Medicine, Experimental; National characteristics; Patient Acceptance of Health Care - statistics & numerical data; Patients; Population; Radiology; Regression analysis; Resource utilization; Surveys; United States - epidemiology; Utilization; Vital signs; United States; United States > US; National characteristics; End-stage renal disease; Resource utilization; Emergency medicine
• ISSN: 1471-227X; 1471-227X
• DOI: 10.1186/s12873-021-00420-8

We sought to describe the national characteristics of ED visits by patients with end-stage renal disease (ESRD) in the United States in order to improve the emergency treatment and screening of ESRD patients.
We analyzed data from 2014 to 2016 ED visits provided by the National Hospital Ambulatory Medical Care Survey. We sampled adult (age ≥ 18 years) ED patients with ESRD. By proportion or means of weighted sample variables, we quantified annual ED visits by patients with ESRD. We investigated demographics, ED resource utilization, 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.
Approximately 722,692 (7.78%) out of 92,899,685 annual ED visits represented ESRD patients. Males were more likely to be ESRD patients than females (aOR: 1.34; 95% CI: 1.09-1.66). Compare to whites, non-Hispanic Blacks were 2.55 times more likely to have ESRD (aOR: 2.55; 95% CI: 1.97-3.30), and Hispanics were 2.68 times more likely to have ESRD (95% CI: 1.95-3.69). 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.
We described the unique demographic, socioeconomic, and clinical characteristics of ED patients with ESRD, using the most comprehensive, nationally representative study to date. These patients' higher hospital and ICU admission rates indicate that patients with ESRD require a higher level of emergency care.