Abstract: TH-OR43
Comprehensive Conservative Kidney Management among an Older Population Using a Large Administrative Claims Database
Session Information
- CKD: Novel Risk Factors and Consequences
October 24, 2024 | Location: Room 24, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Kobayashi, Arisa, Kyoto Daigaku Daigakuin Igaku Kenkyuka Igakubu, Kyoto, Kyoto, Japan
- Hirano, Keita, Kyoto Daigaku Daigakuin Igaku Kenkyuka Igakubu, Kyoto, Kyoto, Japan
- Ikenoue, Tatsuyoshi, Kyoto Daigaku Daigakuin Igaku Kenkyuka Igakubu, Kyoto, Kyoto, Japan
- Yokoo, Takashi, Tokyo Jikeikai Ika Daigaku, Minato-ku, Tokyo, Japan
- Fukuma, Shingo, Kyoto Daigaku Daigakuin Igaku Kenkyuka Igakubu, Kyoto, Kyoto, Japan
Background
Choosing renal replacement therapy for the older is complex due to complications and quality of life concerns. Conservative kidney management (CKM) is increasingly accepted for older CKD patients. This study aims to examine CKM status and related factors in aging Japanese society.
Methods
This cohort study used health screening and medical claims data from April 2014 to May 2023. We included people aged 75 or older with advanced kidney disease (eGFR<8), observed for at least one year and not receiving maintenance dialysis at inclusion. The population was divided into two groups: planned initiation of dialysis (non-CKM group) and selected for CKM (CKM group). A Cox proportional hazards model with age, sex, body mass index (BMI) and frailty categorized by Electronic Frailty Index assessed factors impacting CKM selection. All-cause mortality and total hospitalizations were also examined in both groups.
Results
A total of 480 were included in this analysis (median [IQR] age, 81.1 [77.9-84.8] years; 247 women [51.5%]). Of these, 359 (74.8%) did not undergo necessary practice for dialysis and were defined as choosing CKM. Cox regression showed no significant differences in age, sex, or BMI between the groups. By contrast, the non-frail group was significantly less likely to initiate dialysis compared to the severe-frail group (HR 0.11 [95% CI, 0.02-0.82]). Cox regression analysis of all-cause mortality showed no significant difference between the groups (HR 1.25 [95% CI, 0.70-2.24]). Kaplan-Meier curves for death are shown in the Figure. Poisson regression indicated the hospitalization rate was significantly higher in the non-CKM group (IRR 1.98 [95% CI, 1.67-2.34]). In the non-CKM group, hospitalizations were significantly more frequent in the severe-frail group (OR 8.75 [95% CI, 1.36-56.3]).
Conclusion
In the older population, non-frail individuals often chose CKM. These findings suggest the importance of considering clinical backgrounds when determining CKM indications.