Abstract: FR-PO904

Options Education before Initiation of Dialysis Is Associated to Improved Hospitalization and Mortality Rates

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Jiao, Yue, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Lynch, Rob, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Hymes, Jeffrey L., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

KDOQI guidelines recommend that chronic kidney disease patients receive options education to learn optimal ways to prepare for dialysis. Little is known about the impacts of options education on patient outcomes after the progression to end stage renal disease (ESRD). We investigated if options education is associated with improved hospitalization and mortality outcomes in incident dialysis patients.

Methods

We studied data from incident Fresenius Kidney Care (FKC) patients who initiated dialysis between 2009 and 2016. Patients were grouped by enrollment in FKC options education prior to initiating dialysis or not, as well as whether patients started dialysis as an outpatient or inpatient. In these groups, we calculated and compared the mean annual hospital admission and mortality rate during the first 120 days of dialysis.

Results

We analyzed data from a total of 300,818 patients; of these, 68,721 patients received options education prior to initiating dialysis. Throughout 2009-2016, patients who received options education generally exhibited lower rates of hospital admissions and mortality during the first 120 days of dialysis, as compared to those who did not receive education. Similar findings were observed, yet less pronounced, for admission and mortality rates in patients starting dialysis as an inpatient versus outpatient. Specifically, in 2016 outpatients without education had 1.74 admissions per patient year (ppy) and 0.19 deaths per 100 patient years (p100py). When compared to those with education, we observed a 23.6% decrease in admissions (1.33 admissions ppy) and a 52.6% decrease in death rate (0.09 deaths p100py). Inpatients without education had 2.1 admissions ppy and 0.27 deaths p100py, while patients with options education were observed to have a 7.14% decrease in admissions (1.95 admissions ppy) and a 37% decrease in death rate (0.17 deaths p100py).

Conclusion

The analysis herein indicates that receiving options education before progression to ESRD is associated with lower rates of hospital admissions and mortality in the incident dialysis period. More analyses are needed to confirm these observations.

Funding

  • Commercial Support