Kidney Week

Abstract: FR-PO941

Impact of Conservative Management vs. Dialysis on Survival Among US Veterans With Advanced CKD

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - II
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

• Rhee, Connie, University of California Irvine, Irvine, California, United States

Connie Rhee,

• Narasaki, Yoko, University of California Irvine, Irvine, California, United States

Yoko Narasaki,

• Crowley, Susan T., Yale University, New Haven, Connecticut, United States

Susan T. Crowley,

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Mukamel, Dana B., University of California Irvine, Irvine, California, United States

Dana B. Mukamel,

• You, Amy Seung, University of California Irvine, Irvine, California, United States

Amy Seung You,

• Yoon, Ji Hoon, University of California Irvine, Irvine, California, United States

Ji Hoon Yoon,

• Nguyen, Danh V., University of California Irvine, Irvine, California, United States

Danh V. Nguyen,

• Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States

Kamyar Kalantar-Zadeh,

Background

Among >1 million US Veterans with CKD, ~10% of those with advanced kidney disease annually progress to ESKD in whom dialysis is the dominant treatment paradigm. Given high rates of early mortality, healthcare utilization, and withdrawal experienced by dialysis patients, we examined the impact of non-dialytic conservative management (CM) vs. dialysis on survival.

Methods

Using linked national VA, USRDS, and Medicare data, we examined Veterans with advanced CKD (≥2 eGFRs <25 separated by ≥90 days) categorized according to receipt of CM, defined as those who did not receive dialysis within 2-yrs of the index eGFR (1^st eGFR <25), vs. receipt of dialysis within 2-yrs of the index eGFR. We compared survival among CM vs. dialysis patients matched by propensity score (PS) to account for differences in demographics, comorbidities, laboratory tests, medications, and treatment factors (hospitalization, nephrology care within 1-yr of index eGFR) in a 1:1 ratio with a caliper distance of ≤0.2 using complete case analysis.

Results

In the PS-matched cohort of 34,628 patients, 17,314 vs. 17,314 were in the CM vs. dialysis groups, respectively, among whom baseline characteristics were well-balanced. In the overall cohort, there were 24,677 death events over a median (IQR) follow-up of 3.7 (2.2, 5.7) yrs. In the main PS-matched unadjusted model, compared with CM, dialysis was associated with higher all-cause mortality: HR (95%CI) 1.11 (1.08-1.14). Similar findings were observed in analyses doubly-adjusted for PS covariates: HR (95%CI) 1.08 (1.05-1.10) for dialysis (Fig).

Conclusion

In PS-matched analyses, compared with CM, transition to dialysis was associated with higher death risk in US Veterans. Further studies are needed to examine the comparative effectiveness of CM vs. dialysis transition on other hard endpoints and patient-centered outcomes.

Funding

• NIDDK Support