Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease
Introduction: Patients with end-stage renal disease (ESRD) who do not have access to standard dialysis often rely on emergency-only dialysis (EOD) through the emergency department (ED). Compared to standard dialysis, EOD leads to higher hospitalization rates, hospital days, and higher mortality. Our...
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| Format: | Article |
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eScholarship Publishing, University of California
2025-07-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/5761q6p6 |
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| author | Shilpa Raju Micah Ownbey Jennifer Cotton Jamal Jones Jo Abraham Christy Hopkins Emad Awad |
| author_facet | Shilpa Raju Micah Ownbey Jennifer Cotton Jamal Jones Jo Abraham Christy Hopkins Emad Awad |
| author_sort | Shilpa Raju |
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| description | Introduction: Patients with end-stage renal disease (ESRD) who do not have access to standard dialysis often rely on emergency-only dialysis (EOD) through the emergency department (ED). Compared to standard dialysis, EOD leads to higher hospitalization rates, hospital days, and higher mortality. Our objective in this this study was to examine hospitalization rates and total hospital days after transitioning patients with ESRD from ED EOD to scheduled ED dialysis, and subsequently to standard outpatient dialysis. Methods: We performed this retrospective study at a single, academic teaching hospital over the course of 10 years (2014–2023). Patients >18 years of age who received dialysis primarily through the ED for more than one year were included in the study. We studied two cohorts. Cohort 1 consisted of patients with ESRD who transitioned from ED EOD to twice-weekly ED dialysis. Cohort 2 was composed of patients who were transitioned from twice-weekly ED dialysis to standard outpatient dialysis. We performed paired patient analysis using the Wilcoxon signed-rank test. Primary outcomes included hospitalizations per month and total hospital days. Results: Overall, there were seven patients in cohort 1 (mean age 39 years, 86% female) and 20 patients in cohort 2 (mean age 44, 50% female). Patients who transitioned to twice-weekly ED dialysis from ED EOD had lower hospitalizations per month (1.44 vs 0.26, P <.05) and fewer total hospital days per month (2.18 vs 1.20, P < .05). Patients who transitioned from twice-weekly scheduled ED dialysis to standard outpatient dialysis had even lower hospitalizations per month (0.10 vs 0.02, P < .01) and total hospital days (0.31 vs 0.08, P < .01). Conclusion: Introducing scheduled twice-weekly ED dialysis sessions for unfunded patients with end-stage renal disease was associated with lower overall hospitalization rates and hospital days than emergency-only dialysis. These measures were decreased further after transitioning patients from ED scheduled dialysis to standard dialysis. |
| format | Article |
| id | doaj-art-b4b91340802746f3bc1b97f0fb8057c8 |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-b4b91340802746f3bc1b97f0fb8057c82025-08-20T03:41:47ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182025-07-012641047105410.5811/westjem.31053wjem-26-1047Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal DiseaseShilpa Raju0Micah Ownbey1Jennifer Cotton2Jamal Jones3Jo Abraham4Christy Hopkins5Emad Awad6University of Utah Health, Department of Emergency Medicine, Salt Lake City, UtahUniversity of Utah Health, Department of Emergency Medicine, Salt Lake City, UtahUniversity of Utah Health, Department of Emergency Medicine, Salt Lake City, UtahUniversity of Utah Health, Department of Emergency Medicine, Salt Lake City, UtahUniversity of Utah Health, Department of Internal Medicine, Division of Nephrology and Hypertension, Salt Lake City, UtahUniversity of Utah Health, Department of Emergency Medicine, Salt Lake City, UtahUniversity of Utah Health, Department of Emergency Medicine, Salt Lake City, UtahIntroduction: Patients with end-stage renal disease (ESRD) who do not have access to standard dialysis often rely on emergency-only dialysis (EOD) through the emergency department (ED). Compared to standard dialysis, EOD leads to higher hospitalization rates, hospital days, and higher mortality. Our objective in this this study was to examine hospitalization rates and total hospital days after transitioning patients with ESRD from ED EOD to scheduled ED dialysis, and subsequently to standard outpatient dialysis. Methods: We performed this retrospective study at a single, academic teaching hospital over the course of 10 years (2014–2023). Patients >18 years of age who received dialysis primarily through the ED for more than one year were included in the study. We studied two cohorts. Cohort 1 consisted of patients with ESRD who transitioned from ED EOD to twice-weekly ED dialysis. Cohort 2 was composed of patients who were transitioned from twice-weekly ED dialysis to standard outpatient dialysis. We performed paired patient analysis using the Wilcoxon signed-rank test. Primary outcomes included hospitalizations per month and total hospital days. Results: Overall, there were seven patients in cohort 1 (mean age 39 years, 86% female) and 20 patients in cohort 2 (mean age 44, 50% female). Patients who transitioned to twice-weekly ED dialysis from ED EOD had lower hospitalizations per month (1.44 vs 0.26, P <.05) and fewer total hospital days per month (2.18 vs 1.20, P < .05). Patients who transitioned from twice-weekly scheduled ED dialysis to standard outpatient dialysis had even lower hospitalizations per month (0.10 vs 0.02, P < .01) and total hospital days (0.31 vs 0.08, P < .01). Conclusion: Introducing scheduled twice-weekly ED dialysis sessions for unfunded patients with end-stage renal disease was associated with lower overall hospitalization rates and hospital days than emergency-only dialysis. These measures were decreased further after transitioning patients from ED scheduled dialysis to standard dialysis.https://escholarship.org/uc/item/5761q6p6 |
| spellingShingle | Shilpa Raju Micah Ownbey Jennifer Cotton Jamal Jones Jo Abraham Christy Hopkins Emad Awad Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease Western Journal of Emergency Medicine |
| title | Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease |
| title_full | Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease |
| title_fullStr | Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease |
| title_full_unstemmed | Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease |
| title_short | Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease |
| title_sort | impact of twice weekly scheduled dialysis through the emergency department for patients with end stage renal disease |
| url | https://escholarship.org/uc/item/5761q6p6 |
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