Quality

Why Hospitalists Should Pay Special Attention to Kidney Disease


 

Need another reason to hone your skills in treating people with kidney disease?

Take a look at a study out of the University of Washington: Kidney disease, researchers there found, is the diagnosis associated with the highest rate of readmission to the hospital and the emergency room and hospital mortality—controlling for cardiovascular disease, infection, sepsis, encephalopathy and “all the usual suspects associated with readmission,” says Katherine Tuttle, MD, clinical professor of medicine in the University of Washington Division of Nephrology.

The study, which included 676,000 hospitalized patients in Washington state in 2006 through 2008, was done in collaboration with Washington State University and Spokane-based Providence Sacred Heart Medical Center. Researchers found that the highest risk was found in patients on dialysis, but even in early stages of chronic kidney disease there was a significantly increased risk of readmissions and death, Dr. Tuttle said.1

The reasons are not known.

“One reason we think is really important is this issue of medication management,” Dr. Tuttle says.

Researchers then did a pilot study showing that, at the time of discharge, if a pharmacist visited within the first week, the rates of readmission were reduced by 50 percent. “The goal of that visit was basically do what probably should have been done through the hospital, which is adjust drug doses properly for kidney function and address drug interaction,” Dr. Tuttle says.

The research team is working on a large study funded by the National Institutes of Health to validate those findings and look at a broader population of patients. This is more evidence pointing to the importance of handoffs, she says.

"These transitions in care are dangerous situations,” Dr. Tuttle says. “But they’re also opportunities for improvement. And I think anything we can do to enhance education management is likely to be very beneficial in people with chronic kidney disease.”

Hospitalists have "serious work to do in improving continuity in care, and handoffs in general,” she adds.

“So much of what they do in the hospital is influenced by kidney function, whether it’s the drugs they give or the diagnostic tests that they want to do,” she says. “I’m not being critical at all. It’s a new area, relatively speaking, and there are lots of opportunities for improvement in the system.”

Tom Collins is a freelance writer in South Florida.

Reference

1. Risks of subsequent hospitalization and death in patients with kidney disease. Clin J Am Soc Nephrol. 2012;7(3):409-416.

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