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Abstract: SA-PO1112

Hospitalization Outcomes in a National Cohort of Advanced CKD Patients Treated with Conservative Management vs. Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Rhee, Connie, University of California Irvine School of Medicine, Irvine, California, United States
  • Yoon, Ji Hoon, University of California Irvine School of Medicine, Irvine, California, United States
  • Narasaki, Yoko, University of California Irvine School of Medicine, Irvine, California, United States
  • You, Seungsook, University of California Irvine School of Medicine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mukamel, Dana B., University of California Irvine School of Medicine, Irvine, California, United States
  • Crowley, Susan T., Yale University, New Haven, Connecticut, United States
  • Nguyen, Matthew Duy Thanh Luyen, University of California Irvine School of Medicine, Irvine, California, United States
  • Nguyen, Danh V., University of California Irvine School of Medicine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States
Background

Dialysis has been the default treatment strategy in advanced CKD patients progressing to ESKD, yet may be associated with higher healthcare utilization in certain subgroups. We compared hospitalization outcomes in a national cohort of advanced CKD patients treated with conservative management (CM) vs. dialysis.

Methods

We examined advanced CKD patients treated with CM vs. dialysis (defined as non-receipt vs. receipt of dialysis within 2-years of the 1st eGFR <25) over 1/1/07-6/30/20 from the Optum Labs Data Warehouse, which contains de-identified administrative claims, including medical/pharmacy claims and enrollment records for commercial/Medicare Advantage enrollees, and EHR data. In secondary analyses, we examined finer gradations of dialysis timing, defined as earlier dialysis (ED) vs. later dialysis (LD) (eGFRs ≥15 vs. <15 at dialysis transition); in tertiary analyses we compared ED, intermediate dialysis (ID), vs. very-late dialysis (VLD) (eGFRs ≥15, 10-<15, vs. <10 at dialysis transition). We compared rates of hospitalization (primary outcome) and days hospitalized (secondary outcome) in CM vs. dialysis patients matched by propensity score (PS) in a 1:1 ratio with a caliper distance of ≤0.2 using Poisson regression.

Results

Among 28,850 CM patients PS-matched to 28,850 dialysis patients, dialysis transition was associated with higher rates of hospitalization and days hospitalized vs. CM: IRRs (95%CIs) 2.21 (2.19, 2.23) (Fig A) and 2.80 (2.75, 2.86) (Fig B), respectively. In secondary and tertiary analyses, compared to CM patients, those who transitioned to dialysis had higher rates of hospitalization and days hospitalized vs. CM, irrespective of timing of dialysis initiation.

Conclusion

Patients treated with CM had lower rates of hospitalization and days hospitalized vs. those who transitioned to dialysis. Further studies are needed to determine the downstream sequelae of the differential hospitalization patterns in CM vs. dialysis patients.

Funding

  • NIDDK Support