Kidney Week

Abstract: TH-PO871

Comorbidity Trends in US Veterans With Advanced CKD Patients Treated With Conservative Management vs. Dialysis

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  November 03, 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

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

Yoko Narasaki,

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

Connie Rhee,

• 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

While dialysis has been the dominant treatment paradigm for ESKD, this approach may not offer survival benefit nor improved quality of life in certain subgroups (comorbid, elderly). We examined comorbidity trends in a contemporary cohort of US Veterans with advanced CKD treated with dialysis vs. conservative management (CM).

Methods

In a national cohort of US Veterans, we examined patients with advanced CKD (≥2 eGFRs <25ml/min/1.73m² separated by ≥90 days from 10/2010-9/2019). Using linked USRDS and Medicare (CMS) data, we compared comorbidity trends among patients categorized according to receipt of CM, defined as those who did not receive dialysis within 2-years of the index eGFR (1^st eGFR <25), vs. receipt of dialysis within 2-years of the index eGFR.

Results

Among 106,089 advanced CKD patients who met eligibility, 25% and 75% were treated with dialysis vs. CM, respectively. Compared to the dialysis group, CM patients tended to be younger; were more likely to be White; and less likely to be Black or Hispanic. Median (IQR) Charlson Comorbidity Index (CCI) scores in the dialysis vs. CM groups were 7 (6, 9) and 7 (5, 9), respectively (Fig A). Using CMS Chronic Conditions Data Warehouse algorithms, the most prevalent comorbidities in the dialysis group were diabetes (77%), CHF (65%), PVD (50%), CVD (36%), and history of MI (35%) (Fig B). Among the CM group, the most common comorbidities were diabetes (65%), CHF (58%), COPD (50%), PVD (46%), and CVD (37%).

Conclusion

Among US Veterans with advanced CKD, while there were socio-demographic differences among the dialysis vs. CM groups, comorbidity burden defined by CCI score and types of comorbidities were similar. Further studies are needed to identify the clinical phenotype of patients who will most benefit from dialysis vs. CM.

Funding

• NIDDK Support