Kidney Week

Abstract: SA-PO1137

Nephrologist Visits Lower Rates of Hospitalization, Mortality, and ESKD Transition in Patients with CKD

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

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

Authors

• Karpinski, Steph, Davita Clinical Research, Minneapolis, Minnesota, United States

Steph Karpinski, MA, MS

• O'Shea, Michael H., DaVita Inc, Denver, Colorado, United States

Michael H. O'Shea, MD

• Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli, MD

Background

Chronic kidney disease (CKD) patients require integrated care from a network of healthcare professionals including primary care physicians (PCP) and nephrologists. While it is hypothesized that increased exposure to nephrology care can slow CKD progression and reduce costs, evidence of the impact of primary care has been mixed. Therefore, we sought to determine if CKD stage 4/5 patients benefit clinically because of nephrologist visits, independent of primary care physician exposure.

Methods

This was a retrospective study of 8,941 adult CKD 4/5 patients. For this analysis, we used Optum’s® de-identified Integrated Claims-Clinical Dataset that links administrative claims and clinical data from providers across the continuum of care.¹ The primary exposure (outpatient nephrologist visit: Y/N) was considered over a 6-month period. Outcomes were examined in the subsequent 6 months from exposure and included hospitalizations, mortality, and transition to end-stage kidney disease (ESKD). We modeled the hospitalization outcome using a quasi-Poisson distribution and modeled the ESKD transition and mortality outcomes using binomial distributions, adjusting for age, race, sex, insurance type, baseline CKD state, AKI events, and number of PCP visits (during exposure period). A sensitivity analysis also adjusted for albumin.

Results

After accounting for demographic and clinical factors results indicate that seeing a nephrologist is specifically associated with lower rates of hospitalization [RR (95% CI) 0.81 (0.69, 0.94)], ESKD transitions [OR (95% CI) 0.80 (0.66, 0.98)], and mortality [OR (95% CI) 0.63 (0.48, 0.81)]. The sensitivity analysis yielded similar results.

Conclusion

Among stage 4/5 CKD patients, nephrologist visits over a 6-month period have positive impacts on clinical outcomes.


¹ Optum’s de-identified Integrated Claims-Clinical dataset (2007-2021)