Abstract: FR-PO432
Association between Primary Care Services and All-Cause Mortality among US Patients on In-Center Hemodialysis
Session Information
- Hemodialysis Epidemiology and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Le, Dustin, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Singh, Rohanit, Yale University School of Medicine, New Haven, Connecticut, United States
- Greer, Raquel C., Johns Hopkins Medicine, Baltimore, Maryland, United States
- Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States
- Jaar, Bernard G., Johns Hopkins Medicine, Baltimore, Maryland, United States
Background
The association between primary care evaluation among individuals requiring maintenance in-center hemodialysis (HD) and all-cause mortality is unclear.
Methods
Using the US Renal Data System (USRDS) and Medicare Parts A, B, and D claims data from 2012 to 2020, we estimated the risk of all-cause mortality, cause-specific mortality, and index hospitalization between those with and without PCP services among incident individuals with pre-existing Medicare coverage who survived the first 90 days on HD. Receipt of PCP services was defined as ≥1 outpatient visits between dialysis initiation and study start (90 days after dialysis initiation) to Family Medicine, Internal Medicine, General Medicine, or Geriatrics. We used inverse probability of treatment weights (IPTW) to achieve exchangeability between those with and without primary care evaluation, and we used Cox-proportional hazards models to estimate the IPTW-hazard ratios (HRs).
Results
We identified 58,011 and 56,653 individuals with and without PCP services in the first 90 days of HD. After IPTW, the average age was 71 years old, 53% were White, and 73% had diabetes. There were 58,982 deaths during a median (interquartile interval) follow-up of 1.78 (0.69 – 3.36) years. The median survival for those with PCP services was 3.2 years vs 3.0 years (a difference of 3.4 months). The IPTW-HR for all-cause mortality was 0.91 (95% CI: 0.89 – 0.92), and there were similar reductions in CV death (0.94 [0.91 – 0.96]), infectious death (0.87 [0.81 – 0.94]), and index hospitalization (0.98 [0.97 – 1.00], p-value = 0.03). There was no difference in first ED visit (1.00 [0.99 – 1.01]). Subgroup analyses such as age, race, Part D subsidy status, and PCP evaluation 3 months prior to dialysis initiation were generally consistent.
Conclusion
Among US Medicare beneficiaries, primary care evaluation within 90 days of in-center HD initiation was associated with lower all-cause mortality and hospitalization.
Funding
- Other NIH Support