Abstract: TH-PO824

Impact of Pre-Dialysis Acute Hospitalizations on Post-Dialysis Outcomes in Incident Dialysis Patients

Session Information

Category: Dialysis

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

Authors

  • Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

Mortality in end stage renal disease (ESRD) patients is highest during the first year of dialysis. Although survival is similar in hemodialysis (HD) and peritoneal dialysis (PD), overall costs of care are lower in PD. In spite of the increasing burden of cardiovascular (CV) disease and infections with kidney disease progression, the impact of pre-dialysis acute hospitalizations on dialysis modality and on mortality in dialysis patients is not known.

Methods

We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United States Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Using case-mix adjusted logistic regression models (16 variables), we examined the impact of pre-dialysis acute hospitalizations on type of dialysis modality (PD vs. HD) and one-year all-cause mortality. We evaluated 4 groups of patients by cause of hospitalizations: CV related, infection related [INF], both CV and INF [CV+INF]; and neither CV nor INF related.

Results

The sample was 55% male, 63% White with a mean age of 72±11 years. Only 4% of patients received PD as initial modality. Among the study cohort, 89% had at least one pre-dialysis hospitalization [CV-34%; INF-11%; CV + INF-12%; and 33%-neither CV nor INF]. In adjusted analyses, as compared with no pre-dialysis hospitalizations, patients with INF, CV, CV+INF and neither CV nor INF hospitalizations were more likely to be started on HD (odds ratio [OR] 2.7, 95% confidence interval [CI] 2.24-3.26; OR 2.7, CI 2.37-3.08; OR 3.3, CI 2.68-4.08; OR 2.6, CI 2.3-2.93 respectively). In adjusted analyses, one-year mortality was higher with pre-dialysis INF hospitalizations (OR, 1.41; CI 1.28-1.54), CV hospitalizations (OR, 1.47; CI 1.35-1.59) and INF+CV hospitalizations (OR, 1.87; CI 1.7-2.05), compared with no pre-dialysis hospitalizations.

Conclusion

Pre-dialysis hospitalizations are frequent; infection or cardiovascular related hospitalization independently increases the odds of HD vs. PD; and is an independent predictor of one-year mortality in incident dialysis patients. Effects of pre-ESRD hospitalization should be considered while comparing mortality as quality of dialysis care. Reducing pre-ESRD hospitalizations may improve survival and costs of care after initiating dialysis.