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Early repeat hospitalization for fluid overload in individuals with cardiovascular disease and risks: a retrospective cohort study

  • Nephrology - Original Paper
  • Published:
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Abstract

Aims

Fluid overload is a common manifestation of cardiovascular and kidney disease and a leading cause of hospitalizations. To identify patients at risk of recurrent severe fluid overload, we evaluated the incidence and risk factors associated with early repeat hospitalization for fluid overload among individuals with cardiovascular disease and risks.

Methods

Single-center retrospective cohort study of 3423 consecutive adults with an index hospitalization for fluid overload between January 2015 and December 2017 and had cardiovascular risks (older age, diabetes mellitus, hypertension, dyslipidemia, kidney disease, known cardiovascular disease), but excluded if lost to follow-up or eGFR < 15 ml/min/1.73 m2. The outcome was early repeat hospitalization for fluid overload within 30 days of discharge.

Results

The mean age was 73.9 ± 11.6 years and eGFR was 54.1 ± 24.6 ml/min/1.73 m2 at index hospitalization. Early repeat hospitalization for fluid overload occurred in 291 patients (8.5%). After adjusting for demographics, comorbidities, clinical parameters during index hospitalization and medications at discharge, cardiovascular disease (adjusted odds ratio, OR 1.66, 95% CI 1.27–2.17), prior hospitalization for fluid overload within 3 months (OR 2.52, 95% CI 1.17–5.44), prior hospitalization for any cause in within 6 months (OR 1.33, 95% CI 1.02–1.73) and intravenous furosemide use (OR 1.58, 95% CI 1.10–2.28) were associated with early repeat hospitalization for fluid overload. Higher systolic BP on admission (OR 0.992, 95% 0.986–0.998) and diuretic at discharge (OR 0.50, 95% CI 0.26–0.98) reduced early hospitalization for fluid overload.

Conclusion

Patients at-risk of early repeat hospitalization for fluid overload may be identified using these risk factors for targeted interventions.

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Data availability

Data available upon reasonable request and subject to institutional approval.

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Acknowledgements

The authors thank Ms Hanis Bte Abdul Kadir from the Health Services Research Unit, Singapore General Hospital, for her help in data management and processing.

Funding

This study was supported by the SHF-Foundation Research Grant (SHF/HSRHO014/2017).

Author information

Authors and Affiliations

  1. Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore

    Cynthia C. Lim, Dorothy Huang, Zhihua Huang, Li Choo Ng & Chieh Suai Tan

  2. Nursing, Singapore General Hospital, Singapore, Singapore

    Zhihua Huang & Li Choo Ng

  3. SingHealth Polyclinics, Singapore, Singapore

    Ngiap Chuan Tan & Andrew Ang

  4. Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore

    Wei Yi Tay

  5. Department of Endocrinology, Singapore General Hospital, Singapore, Singapore

    Yong Mong Bee

Authors
  1. Cynthia C. Lim
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  2. Dorothy Huang
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Correspondence to Cynthia C. Lim.

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All the authors declare no relevant conflict of interest.

Ethical approval

This study abided by the Declaration of Helsinki and the Centralized Institutional Review Board (2020/3061) determined that the study did not require further ethical deliberation for the use of de-identified data.

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Lim, C.C., Huang, D., Huang, Z. et al. Early repeat hospitalization for fluid overload in individuals with cardiovascular disease and risks: a retrospective cohort study. Int Urol Nephrol 56, 1083–1091 (2024). https://doi.org/10.1007/s11255-023-03747-2

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  • DOI: https://doi.org/10.1007/s11255-023-03747-2

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