Kidney Week

Abstract: TH-PO305

Inpatient vs. Outpatient Dialysis Transition and Hospitalization Outcomes in a National Cohort of Patients with Advanced CKD

Session Information

• Hemodialysis and Frequent Dialysis - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Yoon, Ji Hoon, University of California Los Angeles, Los Angeles, California, United States

Ji Hoon Yoon, MS

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Narasaki, Yoko, University of California Los Angeles, Los Angeles, California, United States

Yoko Narasaki, MS, PhD

• You, Amy Seungsook, University of California Los Angeles, Los Angeles, California, United States

Amy Seungsook You, MS

• Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States

John J. Sim, MD, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

• Novoa Vargas, Alejandra, University of California Los Angeles, Los Angeles, California, United States

Alejandra Novoa Vargas, MPH

• Nguyen, Danh V., University of California Irvine, Irvine, California, United States

Danh V. Nguyen, PhD

• Rhee, Connie, University of California Los Angeles, Los Angeles, California, United States

Connie Rhee, MD, MS

Background

Advanced CKD patients transitioning to ESKD have high morbidity and mortality in the first few months of dialysis initiation. We sought to determine whether transitioning to dialysis in the inpatient vs. outpatient setting is associated with differential hospitalization outcomes among incident ESKD patients.

Methods

We examined advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) who transitioned to dialysis within 2-yrs of their 1^st (index) eGFR <25 over 1/1/07-6/30/20 from the OptumLabs^® Data Warehouse (OLDW), which contains de-identified administrative claims, including medical/pharmacy claims and enrollment records for commercial/Medicare enrollees, and EHR data. We compared hospitalization rates among patients who transitioned to dialysis in the inpatient vs. outpatient setting matched by propensity score (PS) in a 1:1 ratio with a caliper distance of ≤0.2 to address confounding by indication in Poisson models.

Results

Among 84,915 advanced CKD patients who transitioned to dialysis, 20,617 patients who transitioned to dialysis in the outpatient setting were PS-matched to 20,617 patients who transitioned to dialysis in the inpatient setting. In PS-matched models, outpatient dialysis transition was associated with lower hospitalization rates vs. inpatient dialysis transition within 1-yr and 2-yrs after the index eGFR date: IRRs (95%CI) 0.54 (0.53-0.54) and 0.60 (0.60, 0.61), respectively. Similar findings were observed in sensitivity analyses doubly-adjusted for PS-score covariates.

Conclusion

In a national cohort of advanced CKD patients transitioning to ESKD, outpatient dialysis was associated with lower hospitalization rates vs. inpatient dialysis transition.

Funding

• NIDDK Support