Abstract: TH-PO797
An International Multicenter Analysis of Incident Patients on Hemodialysis – Practice Patterns, Vascular Access, Demographics and Laboratory Profiles
Session Information
- Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular
Authors
- Jacobson, Stefan H., Danderyd Hospital, Stockholm, Sweden
- Drozdz, Maciej B., DaVita Poland, Bialystok, Poland
- Weigert, Andre L., Davita, Lisbon, Portugal
- Kleophas, Werner, DaVita Deutschland, Dusseldorf, Germany
- Brzosko, Szymon, DaVita Poland, Bialystok, Poland
- Alsuwaida, Abdulkareem, King Saud University, Riyadh, Saudi Arabia
Background
Mortality rates are particularly high in the first few months following initiation of hemodialysis. The risk is associated with characteristics of predialysis care including delayed nephrology referral, type of vascular access and failure to attain guideline-based targets. In this study we analyzed the clinical characteristics in a large international cohort of incident hemodialysis patients.
Methods
We analyzed patient demographics, practice patterns, and laboratory data (February 2017) from 2592 patients (median age: 62 years; 46% female) receiving hemodialysis at 25 DaVita centers in Poland (8 centers, 529 patients), Portugal (5 centers, 529 patients), and Saudi Arabia (12 centers, 1306 patients) with the objective of comparing incident and prevalent patients. We considered the 10th percentile of time on hemodialysis (4.7 months) and compared practices and laboratory data between incident patients (<4.7 months on dialysis; mean 2 months) and prevalent patients (>4.7; mean 44 months).
Results
Incident patients (n=259) were younger (p<0.001) than prevalent patients (n=2333), and had lower Charlson comorbidity index (p<0.001) and BMI (p<0.001). There were significant differences in renal anemia, nutrition, and mineral bone disease variables (Table) . Incident patients were more often treated using a central dialysis catheter (CDC, p<0.001). The proportion of patients within treatment targets for Kt/V (>1.3), Hb (10-12 g/dL), phosphate (<5.5 mg/dL), albumin (>35 g/L) and treated blood volume (>1 L/kg bw ) were all lower in incident patients compared to prevalent patients (all comparisons p<0.001).
Conclusion
This large, international, multicenter analysis of incident hemodialysis patients indicates that there is opportunity to improve predialysis management, especially in terms of earlier placement of a permanent vascular access prior to start of hemodialysis. Since mortality is high after initiation of dialysis, such efforts may contribute to improved treatment results.
Comparison of 259 incident vs 2333 prevalent patients on hemodialysis (mean values)
| Age | CDC % | BMI | Charlson median | Albumin | Hb | TSAT | Ferritin | Ca | P | PTH | |
| Incident | 57 | 64 | 24.3 | 0 | 37 | 10.8 | 28,4 | 343 | 8.6 | 5.3 | 412 |
| Prevalent | 62 | 24 | 25.2 | 2 | 39 | 11.1 | 29.0 | 507 | 8.8 | 4.8 | 465 |
| p | <0.001 | <0.001 | <0.05 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.05 | <0.001 | NS |