ESRD Outcomes Following Incident Hemodialysis

Background: Managing end-stage renal disease (ESRD) is challenging, with hemodialysis commonly used. While outcomes of maintenance dialysis are well-studied, less is known about patients who undergo emergency dialysis and are discharged without provisions for maintenance hemodialysis This study evaluated 90-day outcomes—rehospitalization, death, and emergency visits in such patients at a tertiary center, and explored links between Charlson Comorbidity Index (CCI) scores and adverse outcomes, along with renal service delivery during this period. Methods: A total of 93 consenting ESRD patients who received incident hemodialysis during the study period, four succumbed during the index admission and 14 were lost to follow-up, leaving 75 patients for analysis. Data on 90-day outcomes—rehospitalization, death, and emergency visits were collected. Charlson Comorbidity Index (CCI) scores were recorded at the time of initial dialysis. Information on post-discharge renal care dialysis access, prescription refills, monthly out-of-pocket costs and vascular access was also gathered. Results: The study involved participants with a mean age of 44.66 years, 51% of whom were female. Findings showed that 38.7% were rehospitalized, 32% succumbed, and 52% visited the emergency department. A significant link was found between the Charlson Comorbidity Index one-year survival probability and mortality (p=0.02). Financial insufficiency was the main barrier to optimal dialysis. Conclusion: ESRD patients discharged after incident hemodialysis without care continuity face high rates of poor outcomes, including significant mortality and frequent emergency visits. The CCI may aid in triage and prognosis. Discordant availability of cost-effective renal services were the major impediment in continuity of care.