Background Hospitalizations and 30-day readmissions are common in the hemodialysis population. Actionable clinical markers for near-term hospital encounters are needed to identify individuals who require swift intervention to avoid hospitalization. Aspects of volume management, such as failed target weight (i.e, estimated dry weight) achievement, are plausible modifiable indicators of impending adverse events. The short-term consequences of failed target weight achievement are not well established.

Methods Statistically deidentified data were taken from a cohort of Medicare-enrolled, prevalent hemodialysis patients treated at a large dialysis organization from 2010 to 2012. We used a retrospective cohort design with repeated intervals, each consisting of 180-day baseline, 30-day exposure assessment, and 30-day follow-up period, to estimate the associations between failed target weight achievement and the risk of 30-day emergency department visits and hospitalizations. We estimated adjusted risk differences using inverse probability of exposure weighted Kaplan–Meier methods.

Results A total of 113,561 patients on hemodialysis contributed 788,722 study intervals to analyses. Patients who had a postdialysis weight >1.0 kg above the prescribed target weight in ≥30% (versus <30%) of exposure period treatments had a higher absolute risk (risk difference) of 30-day: emergency department visits (2.13%; 95% confidence interval, 2.00% to 2.32%); and all-cause (1.47%; 95% confidence interval, 1.34% to 1.62%), cardiovascular (0.31%; 95% confidence interval, 0.24% to 0.40%), and volume-related (0.15%; 95% confidence interval, 0.11% to 0.21%) hospitalizations.

Conclusions In the absence of objective measures of volume status, recurrent failure to achieve target weight is an easily identifiable clinical risk marker for impending hospital encounters among patients on hemodialysis.

背景技术在血液透析人群中，住院和再次住院30天很常见。需要用于近期医院遭遇的可操作临床标记，以识别需要迅速干预以避免住院的个人。体积管理的各个方面，例如达不到目标体重（即估计的干重），是即将发生的不良事件的合理可修改指标。未能达到目标体重的短期后果尚不明确。

方法：从2010年至2012年在大型透析机构接受Medicare登记的流行性血液透析患者队列中，采用统计上不确定的数据。我们采用回顾性队列研究设计，每隔180天进行基线研究，重复间隔30天评估和30天的随访期，以评估达标失败的体重与30天急诊就诊和住院风险之间的关联。我们使用暴露加权加权Kaplan-Meier方法的逆概率来估计调整后的风险差异。

结果总共113,561名接受血液透析的患者贡献了788,722个研究间隔。在暴露期治疗中≥30％（高于<30％）且透析后体重超过规定目标体重> 1.0 kg的患者，其30天的绝对风险较高（风险差异）：急诊就诊（2.13％; 95） ％置信区间，2.00％至2.32％）；和全因（1.47％; 95％置信区间为1.34％至1.62％），心血管（0.31％; 95％置信区间为0.24％至0.40％）和与体积相关的（0.15％; 95％置信区间， 0.11％至0.21％）的住院率。

结论在缺乏客观的容量状态指标的情况下，反复达到目标体重的失败是容易确定的临床风险标志，是即将进行血液透析的患者在医院中遇到的危险。