Article Instance
API Endpoint for journals.
GET /api/articles/31053/?format=api
{ "pk": 31053, "title": "Impact of Twice-weekly Scheduled Dialysis Through the Emergency Department for Patients with End-stage Renal Disease", "subtitle": null, "abstract": "<p><strong>Introduction:</strong> Undocumented immigrant patients with end stage kidney disease (ESKD) who do not have access to standard dialysis often rely on emergency-only dialysis (EOD) through the emergency department (ED). EOD is provided to patients who present with a critical dialysis need, which includes life threatening hyperkalemia, hypoxemia, uremia, and metabolic acidosis. Compared to standard dialysis, emergency-only dialysis leads to worse patient outcomes, higher hospitalization rates, hospital days, and mortality. The objective of this study was to examine hospitalization rates and hospital days after transitioning undocumented patients with ESKD from EOD to scheduled dialysis through the emergency department and subsequently from scheduled emergency department dialysis to standard dialysis (three day a week dialysis).</p>\n<p><strong>Methods:</strong> This was a retrospective study using data from one academic teaching hospital over the course of 10 years (2014-2023). All patients over the age of 18 who received dialysis primarily through the emergency department for more than one year were included in the study. Data from two cohorts was collected. Cohort 1 consisted of undocumented individuals who initially were receiving EOD and later transitioned to twice-weekly dialysis through the ED. Cohort 2 was composed of undocumented patients who transitioned from twice-weekly dialysis through the ED to a standard outpatient dialysis schedule. Patients who only received dialysis during one time period (no comparison time period) were excluded from the analysis. The primary outcome studied was hospitalization rate and hospital days. </p>\n<p><strong>Results:</strong> Overall, there were 7 patients in cohort 1 (mean age = 39, 86% female) and 20 patients in cohort 2 (mean age= 44, 50% female). Analysis of hospitalization rates and hospital days was performed using the Wilcoxon signed-rank test. Analysis demonstrated that transitioning from EOD dialysis to twice-weekly dialysis was associated with lower hospitalization rates (1.44 vs. 0.26, p < 0.05) and decreased total hospital days per month (2.18 vs. 1.20, p < 0.05). Switching from twice-weekly dialysis to standard outpatient dialysis was associated with significantly fewer hospitalizations per month (0.10 vs. 0.02, p < 0.01) and lower hospital days per month compared to the twice-weekly dialysis regimen (0.31 vs. 0.08, p < 0.01).</p>\n<p><strong>Conclusion:</strong> Introducing scheduled twice weekly dialysis sessions for undocumented patients with end stage kidney disease through the emergency department was associated with lower overall hospitalization rates and hospital days. Moving to the standard thrice weekly dialysis was associated with even lower hospitalizations and hospital days.</p>", "language": "eng", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Emergency Only Dialysis" }, { "word": "end stage kidney disease" }, { "word": "undocumented immigrants" }, { "word": "Health Care Utilization" } ], "section": "Health Outcomes", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5761q6p6", "frozenauthors": [ { "first_name": "Shilpa", "middle_name": "", "last_name": "Raju", "name_suffix": "", "institution": "University of Utah Health, Department of Emergency Medicine, Salt Lake City, Utah", "department": "" }, { "first_name": "Micah", "middle_name": "", "last_name": "Ownbey", "name_suffix": "", "institution": "University of Utah Health, Department of Emergency Medicine, Salt Lake City, Utah", "department": "" }, { "first_name": "Jennifer", "middle_name": "", "last_name": "Cotton", "name_suffix": "", "institution": "University of Utah Health, Department of Emergency Medicine, Salt Lake City, Utah", "department": "" }, { "first_name": "Jamal", "middle_name": "", "last_name": "Jones", "name_suffix": "", "institution": "University of Utah Health, Department of Emergency Medicine, Salt Lake City, Utah", "department": "" }, { "first_name": "Jo", "middle_name": "", "last_name": "Abraham", "name_suffix": "", "institution": "University of Utah Health, Department of Internal Medicine, Division of Nephrology and Hypertension, Salt Lake City, Utah", "department": "" }, { "first_name": "Christy", "middle_name": "", "last_name": "Hopkins", "name_suffix": "", "institution": "University of Utah Health, Department of Emergency Medicine, Salt Lake City, Utah", "department": "" }, { "first_name": "Emad", "middle_name": "", "last_name": "Awad", "name_suffix": "", "institution": "University of Utah Health, Department of Emergency Medicine, Salt Lake City, Utah", "department": "" } ], "date_submitted": "2024-07-29T16:13:06.216000-07:00", "date_accepted": "2025-03-22T13:10:35.449000-07:00", "date_published": "2025-07-08T14:46:00-07:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/31053/galley/37038/download/" } ] }