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 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.