Abstract: FR-OR19
Real-World Evidence on Hemodialysis Modality and Hospitalization Outcomes
Session Information
- Dialysis: What's New in Techniques and Management
October 25, 2024 | Location: Room 8, Convention Center
Abstract Time: 04:30 PM - 04:40 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Zhang, Yan, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
- Winter, Anke, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
- Alejos, Belen, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
- Carioni, Paola, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy
- Arkossy, Otto, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Hessen, Germany
- Usvyat, Len A., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care AG & Co. KGaA, Bad Homburg, Germany
Background
Recent clinical trials have highlighted the benefits of hemodiafiltration (HDF) for clinical outcomes, such as mortality. We assessed the association of dialysis modality (HDF vs hemodialysis [HD]) with hospital admission and length of stay (LOS) in a large, unselected patient population treated in real-world setting prior to and during COVID-19 pandemic.
Methods
We included 78,608 hemodialysis patients treated in 2019-2022 at NephroCare Clinics of 23 EMEA countries from European Clinical Database (EuCliD®). Rate of all-cause hospital admission and cumulative LOS was calculated separately for patients receiving at least 75% of treatments with HDF or HD during follow-up. Incident rate ratio (IRR) was estimated by negative binomial regression, accounting for patients with multiple events, and adjusted for multiple confounders. Convection volume (standardized by body surface area) specific analyses were conducted by classifying HDF patients into 3 groups: (LV-HDF, <19 L; MV-HDF,19-23 L; HV-HDF>23L).
Results
The mean age of the study population was 63.2 years and 60% were male. During a median follow-up of 22.6 months, HDF patients showed lower rate of both hospital admission and LOS (adjusted IRR [95% CI] of 0.83 [0.81–0.85] and 0.91 [0.87–0.94], respectively), compared to HD patients. Incident patients (vintage <90 days) had higher rate of hospital admission and LOS than prevalent patients (vintage ≥90 days) for both HDF and HD group. However, IRRs of both hospital admission and LOS for HDF group compared to HD group were lower in the incident patients than in the prevalent patients. HV-HDF and MV-HDF showed lowest and intermediate IRR of hospital admission (IRR [95% CI], 0.77 [0.75–0.79] and 0.82 [0.75–0.79], respectively) and LOS (IRR [95% CI], 0.82 [0.75–0.79] and 0.86 [0.75–0.79], respectively).
Conclusion
This study suggests that HDF was associated with reduced rate of hospitalization as well as time that patients spent in the hospital. Our findings add to the growing body of evidence that HDF provides a spectrum of clinical benefits for dialysis patients.