Kidney Week

Abstract: FR-PO339

Regional Differences in Kidney Replacement Therapy in Diabetic Kidney Disease: Apollo Dial DB

Session Information

• Diabetic Kidney Disease: Clinical Modeling, Diagnosis, Education, and More
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Jiao, Yue, Fresenius Medical Care, Waltham, Massachusetts, United States

Yue Jiao, PhD

• Wolf, Melanie, Fresenius Medical Care, Bad Homburg, Germany

Melanie Wolf

• Croft, Kaitlyn Renee, Fresenius Medical Care, Bad Homburg, Germany

Kaitlyn Renee Croft, MSc

• Carioni, Paola, Fresenius Medical Care, Crema, Italy

Paola Carioni

• Soni, Mitesh, Fresenius Medical Care, Waltham, Massachusetts, United States

Mitesh Soni

• Winter, Anke, Fresenius Medical Care, Bad Homburg, Germany

Anke Winter, MD

• Neri, Luca, Fresenius Medical Care, Crema, Italy

Luca Neri, MD, PhD

• Chaudhuri, Sheetal, Fresenius Medical Care, Waltham, Massachusetts, United States

Sheetal Chaudhuri, PhD

• Singh, Kanti, Fresenius Medical Care, Waltham, Massachusetts, United States

Kanti Singh

• Nikam, Milind, Fresenius Medical Care, Singapore, Singapore

Milind Nikam, MD, MBBS

• Stuard, Stefano, Fresenius Medical Care, Bad Homburg, Germany

Stefano Stuard, MD, PhD

• Guinsburg, Adrian M., Fresenius Medical Care, Buenos Aires, Argentina

Adrian M. Guinsburg, MD

• Chatoth, Dinesh K., Fresenius Medical Care, Waltham, Massachusetts, United States

Dinesh K. Chatoth, MD, FASN

• Hymes, Jeffrey L., Fresenius Medical Care, Waltham, Massachusetts, United States

Jeffrey L. Hymes, MD

• Koulechov, Kirill, Fresenius Medical Care, Bad Homburg, Germany

Kirill Koulechov, PhD

• Usvyat, Len A., Fresenius Medical Care, Waltham, Massachusetts, United States

Len A. Usvyat, PhD

• Larkin, John W., Fresenius Medical Care, Waltham, Massachusetts, United States

John W. Larkin, PhD

• Maddux, Franklin W., Fresenius Medical Care AG, Bad Homburg, Hessen, Germany

Franklin W. Maddux, MD

Background

It is unknown if kidney replacement therapy (KRT) types vary in diabetic kidney disease (DKD). We assessed KRT patterns by primary kidney failure etiology in a global database (Apollo Dial DB) representing care in six continents.

Methods

Apollo Dial DB contains longitudinal observation-level data (each treatment, lab, value) from 40 countries in a kidney care network (Fresenius Medical Care, Bad Homburg, DE). Data anonymization was performed in alignment with recommendations from a re-identification risk determination (Privacy Analytics, Ontario, CA). Dataset has >360 variables (demographics, dialysis, diagnoses, labs, medications, surveys, & outcomes) from 01Jan2018-31Mar2021. Analysis assessed KRT rates after dialysis initiation stratified by region. Modality was defined as use of hemodialysis (HD) only, peritoneal dialysis (PD) ever, or transplant.

Results

Among 543,169 adults (age ≥18 years) in 40 countries, 455,769 had a known kidney failure etiology (diabetes=39.8%, other=40.8%, unspecified=19.4%). Overall, 84.8% used HD only, 11.0% used PD, and 4.1% received a transplant for KRT after dialysis initiation. KRT used in DKD showed 40.7% used HD only, 39.1% used PD, and 21.9% received a transplant. PD and transplant rates differed across regions, with lower PD and transplant rates in DKD (Figure 1). Regional differences in unspecified etiology were also present.

Conclusion

KRT patterns in DKD may differ from other etiologies. Worldwide, transplant occurred half as often in DKD; greater regional variations existed. Regionally, PD was less frequently used in DKD, specifically in Northern and Latin America, South Africa, and Eastern Europe. Kidney failure etiology is largely unspecified in select regions. Opportunities may exist in expanding KRT options in DKD.

Funding

• Commercial Support – Fresenius Medical Care