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Abstract: SA-OR33

Impact of Race/Ethnicity and Age on Hospitalization Outcomes in Advanced CKD Patients Treated With Conservative Management vs. Dialysis

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health

Authors

  • Rhee, Connie, University of California Irvine, Irvine, California, United States
  • You, Amy Seung, University of California Irvine, Irvine, California, United States
  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • Mukamel, Dana B., University of California Irvine, Irvine, California, United States
  • Crowley, Susan T., Yale University, New Haven, Connecticut, United States
  • Yoon, Ji Hoon, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Nguyen, Danh V., University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
Background

Given evidence that dialysis results in greater healthcare utilization and morbidity among certain subgroups, there is rising interest in conservative management (CM) as an alternative patient-centered treatment strategy for advanced CKD. Little is known about the comparative effectiveness of CM vs. dialysis on hospitalization outcomes across different races/ethnicities.

Methods

We compared hospitalization rates in advanced CKD patients treated with CM vs. dialysis over 1/07-6/20 from the Optum Labs Data Warehouse, which contains de-identified administrative claims, including medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees as well as EHR data. Patients were categorized according to receipt of CM, defined as those who did not receive dialysis within 2-yrs of the index eGFR (1st eGFR<25), vs. receipt of dialysis parsed as late vs. early dialysis transition (eGFRs <15 vs. ≥15 at dialysis initiation). We used Poisson regression to compare raw and model-based hospitalization rates in CM vs. dialysis patients across race/ethnicity and age.

Results

Among 309,188 advanced CKD patients who met eligibility, 55% of patients had ≥1 hospitalization(s) within 2-yrs of the index eGFR; the most common causes of hospitalization in both the CM and dialysis groups were CHF, respiratory, or HTN-related (Fig A). In Non-Hispanic (NH) White, NH Black, and Hispanic patients, late and early dialysis had higher hospitalization rates than CM, in which early dialysis demonstrated the highest rates across all age groups (Fig B). Among Asian patients, whereas late and early dialysis also had higher hospitalization rates than CM, late dialysis had higher model-based rates than early dialysis, particular in older age groups.

Conclusion

We observed differential relationships between CM vs. dialysis on hospitalization rates across race/ethnicity and age. Further research is needed to determine which patients are optimal candidates for CM vs. dialysis using a personalized approach.

Funding

  • NIDDK Support