Abstract: TH-PO896

Impact of Pre-ESRD Nephrology Care on Early Post-Dialysis Sepsis-Related Hospitalizations

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Agodoa, Lawrence, National Institutes of Health, Bethesda, Maryland, United States
  • Abbott, Kevin C., National Institutes of Health, Bethesda, Maryland, United States
Background

Pre-end-stage renal disease (ESRD) nephrology care has been reported to improve morbidity and mortality in dialysis patients. However, its impact on infectious complications in dialysis patients has not been studied. Herein we assessed the association between pre-ESRD nephrology care and hospitalizations for sepsis within 12 months after initiation of dialysis.

Methods

Using the US Renal Data System database, we identified 282, 571 Medicare primary patients initiated on maintenance dialysis from 1 January 2009 through 1 June 2013, and followed until 31 December 2013. We abstracted Medicare hospital claims for “septicemia” as primary discharge diagnosis, using the International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM) codes 038.xx (x = 0 to 9 inclusive). We conducted Cox regression analyses for sepsis, adjusted for demographic characteristics, cause of ESRD, dialysis modality, comorbidities, vascular access and other clinical variables.

Results

11,614 (5.4%) patients were hospitalized for sepsis within 12 months after start of dialysis, 33% of whom had more than one hospitalization. Patients with pre-ESRD care had a lower incidence rate of early sepsis compared to those without pre-ESRD care (78.4 per 1,000 patient-years (PY) vs. 111.3 per 1,000 PY, respectively; p<0.001). Hospital length of stay was shorter in patients with pre-ESRD care compared to those without pre-ESRD care (13.7 days vs. 17.6 days, p<0.001). In fully adjusted Cox models, pre-ESRD care was associated with significantly lower likelihood for early sepsis (adjusted hazard ratio [aHR] 0.86, 95% CI 0.80-0.91). Compared to patients without pre-ESRD care, those with > 12 months of pre-ESRD care were significantly less likely to be hospitalized for early sepsis (aHR 0.78, 95% CI 0.71-0.86) but the association with those who had 6-12 months of pre-ESRD care was nonsignificant (aHR 0.95, 95% CI 0.86-1.05).

Conclusion

Pre-ESRD nephrology care was associated with lower risk of sepsis-related hospitalizations within 12 months of dialysis initiation.

Disclaimer: The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of the Army/Navy/Air Force, the Department of Defense, National Institutes of Health, or the United States government.