Kidney Week

Abstract: FR-PO439

Emergency-Only Dialysis and the Impact of Transition to Scheduled Dialysis on Survival of Patients with ESKD

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

• Imber, Jared G., The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States

Jared G. Imber

• Molony, Donald A., The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States

Donald A. Molony, MD

• Rahbar, Mohammad H., The University of Texas Health Science Center at Houston, Houston, Texas, United States

Mohammad H. Rahbar, PhD

• Hessabi, Manouchehr, The University of Texas Health Science Center at Houston, Houston, Texas, United States

Manouchehr Hessabi, MD, MPH

• Yazdani, Akram, The University of Texas Health Science Center at Houston, Houston, Texas, United States

Akram Yazdani, MSc, PhD

• Tahanan, Amirali, The University of Texas Health Science Center at Houston, Houston, Texas, United States

Amirali Tahanan, MS

• Trivedi, Rekha K., Harris Health System, Houston, Texas, United States

Rekha K. Trivedi

• Teakell, Jade M., The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Houston, Texas, United States

Jade M. Teakell, MD, PhD, FASN

Background

Patients with end-stage kidney disease (ESKD) without access to scheduled dialysis present to emergency departments (ED) when their clinical status deteriorates to the extent that they require hemodialysis (HD) emergently to evade death. We hypothesize that the patients who receive emergency-only HD (EOHD) and are subsequently transitioned to scheduled HD or peritoneal dialysis (PD) will have increased overall survival compared to those patients who continued to receive EOHD.

Methods

We interrogated the electronic medical record of the Harris Health System (Houston, TX) to evaluate health outcomes for all adult patients with ESKD requiring dialysis (identified using ICD-10 codes) from 2017 to 2021. We compared overall survival in an EOHD cohort between patients who were transitioned to scheduled dialysis (HD or PD) and those who continued EOHD.

Results

We evaluated the outcomes for 914 adults diagnosed with ESKD without eligibility for or access to a conventional funding source for outpatient dialysis. Of the identified patients, 516 received EOHD, and 398 transitioned to scheduled dialysis (382 HD, 16 PD). Patients receiving EOHD demonstrated an adjusted hazard ratio of 4.553 (95% CI 2.20-9.34) when followed for ≤1 year, 2.222 (95% CI 1.07-4.60) when followed for 1-3 years (total), and 0.2199 (95% CI 0.08-0.61) when followed 3-5 years (total) (Table 1).

Conclusion

The cohort of patients with ESKD who transitioned from EOHD to scheduled dialysis treatments benefited from improved overall survival compared to the patients who continued to receive EOHD, except for those with a follow-up period of 3-5 years. The observed relative improvement in survival outcomes in the EOHD group with greater than 3 years of follow-up is likely due to a survivor effect. These findings provide further evidence that transitioning patients from emergency-only HD to scheduled dialysis as the standard of care will result in better outcomes in this marginalized group of ESKD patients.

Funding

• Other NIH Support