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Abstract: FR-PO965

Impact of Conservative Management vs. Dialysis Transition on Survival in a National Advanced CKD Cohort

Session Information

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

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
  • You, Seungsook, University of California Irvine School of Medicine, Irvine, California, United States
  • Narasaki, Yoko, 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
  • Torres Rivera, Silvina, 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

While dialysis has been the dominant treatment paradigm in advanced CKD patients progressing to ESKD, this approach may lead to impaired physical function, independence, and quality of life among certain subpopulations. We compared the impact of non-dialytic conservative management (CM) vs. dialysis on survival in a national advanced CKD cohort.

Methods

We compared survival in advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) treated with CM vs. dialysis (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), and in tertiary analyses we compared ED, intermediate dialysis (ID), vs. very-late dialysis (VLD) (eGFRs ≥15, 10-<15, vs. <10 at dialysis). We compared survival in CM vs. dialysis patients matched by propensity score (PS) in a 1:1 ratio to address confounding by indication using Cox models.

Results

In 28,829 CM patients PS-matched to 28,829 dialysis patients, dialysis transition was associated with higher mortality vs. CM: HR (95%CIs) 1.18 (1.16, 1.21). In secondary analyses, both ED and LD were each associated with higher mortality vs. CM: HRs (95%CIs) 1.21 (1.17, 1.25) and 1.17 (1.14, 1.20), respectively. In tertiary analyses, increasingly earlier dialysis transition was associated with worse survival vs. CM. Similar findings were observed in sensitivity analyses doubly-adjusted for PS covariates.

Conclusion

Patients treated with CM as an alternative patient-centered treatment strategy had lower mortality risk compared to dialysis, irrespective of dialysis transition timing. Further studies are needed to examine the comparative effectiveness of CM vs. dialysis on CKD outcomes.

Funding

  • NIDDK Support