{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:17:39Z","timestamp":1788913059811,"version":"build-2803163510"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population.<\/jats:p><\/jats:sec>Objective<\/jats:title>To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease\u2013specific ambulatory care\u2013sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use.<\/jats:p><\/jats:sec>Results<\/jats:title>The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34\u202f029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P<\/jats:italic>\u2009&amp;lt;\u2009.001); to experience heart failure (46.8% vs 39.9%; P<\/jats:italic>\u2009=\u2009.001), depression (36.6% vs 32.5%; P<\/jats:italic>\u2009=\u2009.03), and chronic pain (60.1% vs 54.9%; P<\/jats:italic>\u2009=\u2009.01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P<\/jats:italic>\u2009&amp;lt;\u2009.001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, \u22653 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.13754","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T15:01:36Z","timestamp":1716994896000},"page":"e2413754","source":"Crossref","is-referenced-by-count":9,"title":["Emergency Department Use Among Adults Receiving Dialysis"],"prefix":"10.1001","volume":"7","author":[{"given":"Paul E.","family":"Ronksley","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayler D.","family":"Scory","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"McRae","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"MacRae","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Braden J.","family":"Manns","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddy","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maoliosa","family":"Donald","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda R.","family":"Hemmelgarn","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan J.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"},{"name":"Department of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,29]]},"reference":[{"issue":"26","key":"zoi240471r1","first-page":"1","article-title":"National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary.","author":"Niska","year":"2010","journal-title":"Natl Health Stat Report"},{"issue":"8","key":"zoi240471r2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203316","article-title":"Emergency department crowding: a systematic review of causes, consequences and solutions.","volume":"13","author":"Morley","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"zoi240471r3","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.annemergmed.2010.01.032","article-title":"Frequent users of emergency departments: the myths, the data, and the policy implications.","volume":"56","author":"LaCalle","year":"2010","journal-title":"Ann Emerg Med"},{"issue":"2","key":"zoi240471r4","doi-asserted-by":"publisher","first-page":"304","DOI":"10.2215\/CJN.06280616","article-title":"Emergency department use among patients with CKD: a population-based analysis.","volume":"12","author":"Ronksley","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"issue":"4","key":"zoi240471r5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195323","article-title":"Patterns of emergency department utilization by patients on chronic dialysis: a population-based study.","volume":"13","author":"Komenda","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"zoi240471r6","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1186\/s12913-014-0519-z","article-title":"Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data.","volume":"14","author":"Morris","year":"2014","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"zoi240471r7","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.2215\/CJN.01210406","article-title":"Hospital resource utilization that occurs with, rather than because of, kidney failure in patients with end-stage renal disease.","volume":"1","author":"Ross","year":"2006","journal-title":"Clin J Am Soc Nephrol"},{"issue":"10","key":"zoi240471r8","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000014816","article-title":"Hemodialysis interval and its association with emergency care and mortality: a nationwide population-based cohort study.","volume":"98","author":"Chien","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"zoi240471r9","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1038\/ki.2015.141","article-title":"The mortality and hospitalization rates associated with the long interdialytic gap in thrice-weekly hemodialysis patients.","volume":"88","author":"Fotheringham","year":"2015","journal-title":"Kidney Int"},{"issue":"12","key":"zoi240471r10","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1056\/NEJMoa1103313","article-title":"Long interdialytic interval and mortality among patients receiving hemodialysis.","volume":"365","author":"Foley","year":"2011","journal-title":"N Engl J Med"},{"key":"zoi240471r11","doi-asserted-by":"publisher","DOI":"10.1177\/2054358118780372","article-title":"Hospitalizations in dialysis patients in Canada: a national cohort study.","author":"Molnar","year":"2018","journal-title":"Can J Kidney Health Dis"},{"issue":"10","key":"zoi240471r12","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1001\/jamainternmed.2016.4975","article-title":"Emergency department use and hospital admissions among patients with end-stage renal disease in the United States.","volume":"176","author":"Lovasik","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"11","key":"zoi240471r13","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.2215\/CJN.04690416","article-title":"Potentially preventable hospitalization among patients with CKD and high inpatient use.","volume":"11","author":"Ronksley","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"issue":"6","key":"zoi240471r14","doi-asserted-by":"publisher","first-page":"e64","DOI":"10.1111\/acem.2011.18.issue-6","article-title":"Frequent users of emergency department services: gaps in knowledge and a proposed research agenda.","volume":"18","author":"Pines","year":"2011","journal-title":"Acad Emerg Med"},{"issue":"1","key":"zoi240471r15","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1186\/s12913-016-1852-1","article-title":"Individual predictors of frequent emergency department use: a scoping review.","volume":"16","author":"Krieg","year":"2016","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"zoi240471r16","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1186\/s12877-019-1197-9","article-title":"Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review.","volume":"19","author":"Dufour","year":"2019","journal-title":"BMC Geriatr"},{"issue":"1","key":"zoi240471r17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0147116","article-title":"Emergency department frequent utilization for non-emergent presentments: results from a regional urban trauma center study.","volume":"11","author":"Behr","year":"2016","journal-title":"PLoS One"},{"key":"zoi240471r18","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/1471-2369-10-30","article-title":"Overview of the Alberta Kidney Disease Network.","volume":"10","author":"Hemmelgarn","year":"2009","journal-title":"BMC Nephrol"},{"issue":"10","key":"zoi240471r19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement.","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"issue":"4","key":"zoi240471r20","first-page":"164","article-title":"The Southern Alberta Renal Program database: a prototype for patient management and research initiatives.","volume":"24","author":"Manns","year":"2001","journal-title":"Clin Invest Med"},{"issue":"3","key":"zoi240471r21","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1377\/hlthaff.15.3.239","article-title":"Recent findings on preventable hospitalizations.","volume":"15","author":"Billings","year":"1996","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"zoi240471r22","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1377\/hlthaff.12.1.162","article-title":"Impact of socioeconomic status on hospital use in New York City.","volume":"12","author":"Billings","year":"1993","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"zoi240471r23","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1053\/j.ajkd.2014.03.012","article-title":"Potentially preventable hospitalization as a complication of CKD: a cohort study.","volume":"64","author":"Wiebe","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"10","key":"zoi240471r24","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1503\/cmaj.080063","article-title":"Access to health care among status Aboriginal people with chronic kidney disease.","volume":"179","author":"Gao","year":"2008","journal-title":"CMAJ"},{"issue":"1","key":"zoi240471r25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2307\/2137284","article-title":"Revisiting the behavioral model and access to medical care: does it matter?","volume":"36","author":"Andersen","year":"1995","journal-title":"J Health Soc Behav"},{"issue":"4","key":"zoi240471r26","doi-asserted-by":"publisher","first-page":"178","DOI":"10.24095\/hpcdp.29.4.05","article-title":"A deprivation index for health planning in Canada.","volume":"29","author":"Pampalon","year":"2009","journal-title":"Chronic Dis Can"},{"key":"zoi240471r27","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12911-015-0155-5","article-title":"Methods for identifying 30 chronic conditions: application to administrative data.","volume":"15","author":"Tonelli","year":"2015","journal-title":"BMC Med Inform Decis Mak"},{"issue":"10","key":"zoi240471r29","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1097\/00001888-197510000-00006","article-title":"Continuity of care in a university-based practice.","volume":"50","author":"Breslau","year":"1975","journal-title":"J Med Educ"},{"issue":"6","key":"zoi240471r30","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1109\/TAC.1974.1100705","article-title":"A new look at the statistical model identification.","volume":"19","author":"Akaike","year":"1974","journal-title":"IEEE Trans Automat Contr"},{"issue":"2","key":"zoi240471r32","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/BF03404951","article-title":"Hospitalization for ambulatory care-sensitive conditions: a method for comparative access and quality studies using routinely collected statistics.","volume":"92","author":"Brown","year":"2001","journal-title":"Can J Public Health"},{"issue":"6","key":"zoi240471r33","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1136\/bmjqs-2018-008820","article-title":"Ambulatory care-sensitive conditions: their potential uses and limitations.","volume":"28","author":"Hodgson","year":"2019","journal-title":"BMJ Qual Saf"},{"issue":"6","key":"zoi240471r34","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1136\/bmjqs-2018-008002","article-title":"Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis.","volume":"28","author":"Lynch","year":"2019","journal-title":"BMJ Qual Saf"},{"issue":"2","key":"zoi240471r35","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-032755","article-title":"The Child Opportunity Index 2.0 and hospitalizations for ambulatory care sensitive conditions.","volume":"148","author":"Krager","year":"2021","journal-title":"Pediatrics"},{"issue":"10","key":"zoi240471r36","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1097\/00007611-199910000-00009","article-title":"Patient characteristics associated with hospitalizations for ambulatory care sensitive conditions in South Carolina.","volume":"92","author":"Shi","year":"1999","journal-title":"South Med J"},{"issue":"3","key":"zoi240471r37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229465","article-title":"Risk factors for avoidable hospitalizations in Canada using national linked data: a retrospective cohort study.","volume":"15","author":"Wallar","year":"2020","journal-title":"PLoS One"},{"issue":"7","key":"zoi240471r38","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.4852","article-title":"Comparison of the complexity of patients seen by different medical subspecialists in a universal health care system.","volume":"1","author":"Tonelli","year":"2018","journal-title":"JAMA Netw Open"},{"issue":"4","key":"zoi240471r39","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1038\/ki.2015.228","article-title":"Comorbidity as a driver of adverse outcomes in people with chronic kidney disease.","volume":"88","author":"Tonelli","year":"2015","journal-title":"Kidney Int"},{"issue":"4","key":"zoi240471r40","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1053\/j.ajkd.2021.02.327","article-title":"Burden of kidney disease, health-related quality of life, and employment among patients receiving peritoneal dialysis and in-center hemodialysis: findings from the DOPPS program.","volume":"78","author":"Brown","year":"2021","journal-title":"Am J Kidney Dis"},{"issue":"7","key":"zoi240471r41","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1093\/ndt\/gfaa346","article-title":"Perspectives on mental health among patients receiving dialysis.","volume":"36","author":"Nataatmadja","year":"2020","journal-title":"Nephrol Dial Transplant"},{"issue":"4","key":"zoi240471r42","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1007\/s11482-015-9431-x","article-title":"Validation of the Personal Wellbeing Index for people with end stage kidney disease.","volume":"11","author":"Weinberg","year":"2016","journal-title":"Appl Res Qual Life"},{"key":"zoi240471r43","doi-asserted-by":"publisher","first-page":"577","DOI":"10.2147\/PPA","article-title":"The impact on quality of life of dialysis patients with renal insufficiency.","volume":"12","author":"Dabrowska-Bender","year":"2018","journal-title":"Patient Prefer Adherence"},{"issue":"2","key":"zoi240471r44","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2021.09.007","article-title":"Emergency department utilization among maintenance hemodialysis patients: a systematic review.","volume":"4","author":"Han","year":"2021","journal-title":"Kidney Med"},{"issue":"6","key":"zoi240471r45","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1053\/j.ajkd.2020.04.006","article-title":"Outpatient interventions for managing acute complications of chronic diseases: a scoping review and implications for patients with CKD.","volume":"76","author":"Elliott","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"zoi240471r46","doi-asserted-by":"publisher","DOI":"10.1177\/20543581211018528","article-title":"Cost of potentially preventable hospitalizations among adults with chronic kidney disease: a population-based cohort study.","author":"Chong","year":"2021","journal-title":"Can J Kidney Health Dis"},{"issue":"3","key":"zoi240471r47","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1370\/afm.2813","article-title":"Determining the association between continuity of primary care and acute care use in chronic kidney disease: a retrospective cohort study.","volume":"20","author":"Chong","year":"2022","journal-title":"Ann Fam Med"},{"key":"zoi240471r28","unstructured":"Medical Council of Canada. List of normal lab values. Accessed June 1, 2023. https:\/\/mcc.ca\/examinations-assessments\/resources-to-help-with-exam-prep\/normal-lab-values\/\"https:\/\/mcc.ca\/objectives\/normal-values\/\""},{"key":"zoi240471r31","unstructured":"Canadian Institute for Health Information. Ambulatory care sensitive conditions. Accessed July 11, 2023. https:\/\/www.cihi.ca\/en\/indicators\/ambulatory-care-sensitive-conditions"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2819136\/ronksley_2024_oi_240471_1715884789.49355.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T15:01:41Z","timestamp":1716994901000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2819136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,29]]},"references-count":47,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.13754","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,29]]}}}