Dialysis patients discharged from hospitals on Fridays or Saturdays are at increased risk of readmission within 30 days compared with those who are discharged on other days, according to findings presented at the 52^nd congress of the European Renal Association-European Dialysis and Transplant Association in London.

The finding suggests that intensified medical attention and monitoring, such as expanded weekend coverage by a dialysis-specific case manager may be needed for patients discharged on Friday or Saturday, researchers concluded.

Len Usvyat, PhD, and colleagues at Fresenius Medical Care North America, studied 1,305 dialysis patients in West Virginia, Kentucky, and Ohio. The cohort had 3,206 index hospitalizations and 1,123 readmissions within 30 days of discharge, for a mean readmission rate of 35%. The 30-day readmission rates for patients discharged on Friday and Saturday were 35% and 37%, respectively. The rates were 32%, 31%, 34%, 34%, and 33% for those discharged on Sunday, Monday, Tuesday, Wednesday, and Thursday, respectively. Compared with Sunday through Thursday discharges, Friday and Saturday discharges were associated with a significant 22% increased risk of 30-day readmission, the investigators reported.

“In light of the substantial rural nature of this population, further investigations of other geographically distributed populations are warranted to confirm the findings of this study,” they concluded in their study abstract.

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High body mass index (BMI) may identify patients who are at increased risk of progressive chronic kidney disease (CKD), British researchers reported at the 52^nd congress of the European Renal Association-European Dialysis and Transplant Association in London.

Rupert W. Major, MBChB, a Kidney Research U.K. Fellow at the University of Leicester in the U.K., and colleagues studied a cohort of 31,274 patients with an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m² (mean 51.1) as calculated using the Modification of Diet in Renal Disease study equation. Of these patients, 64.7% had 2 eGFR results more than 3 months apart. The cohort had a mean BMI of 28.2 kg/m², and 28.7%, 38.8%, and 30.8% had a BMI of 18–25 (normal), 25-30 (overweight), and greater than 30 kg/m² (obese or severely obese). Results showed that the mean decline in eGFR was greater in the higher BMI categories. The mean eGFR declined by 0.11 and 0.08 mL/min/1.73 m² per year in patients with a BMI of 30–35 and greater than 35 kg/m², respectively, compared with no change or even slight increases in eGFR in the other BMI categories. The decline in eGFR in the higher BMI categories was especially pronounced in younger patients with higher levels of proteinuria, according to the investigators.

“The association we found suggests that reducing BMI might slow the progression of CKD,” Dr. Major told Renal & Urology News. “Lifestyle interventions, such as exercise and dietary programs, are potential areas for intervention in this area, particularly in primary care. At the University of Leicester, and other international renal research centers, we are running structured exercise program clinical trials in CKD to investigate the effect on outcomes, including CKD progression.”

Dr. Major noted that previous studies have focused on the relationship of BMI and the diagnosis of CKD, including a study by his colleagues suggesting that waist circumference may be a potential CKD screening tool. In contrast, the current study, funded by the U.K.'s National Institute for Health Research, focused on progression of disease in patients with known CKD, and the study included what is probably the largest cohort to date to examine the association, he said.

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