Abstract: TH-PO549

Impacts of Pre-Dialysis Options Education on Albumin Levels and Catheter Use in Patients Starting Dialysis

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Jiao, Yue, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Reviriego-Mendoza, Marta, 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

Options education before progression to end stage renal disease (ESRD) teaches patients about optimal ways to prepare for dialysis (e.g. early access placement, nutritional requirements, renal replacement therapy options). We aimed to understand whether patients receiving options education prior to initiating dialysis exhibited improvements in their albumin (Alb) levels and rates of catheter use.

Methods

We analyzed 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 the annual mean Alb levels in all dialysis patients and percent catheter use during the first 120 days of dialysis in hemodialysis patients.

Results

We studied data from a total of 300,818 patients, of which 68,721 patients received options education prior to initiating dialysis. Throughout 2009-2016, patients who received options education generally exhibited higher mean Alb levels and there was a lower proportion of patients with a catheter, as compared to those who did not receive education. These observations were similar, yet less pronounced for catheter use in patients starting dialysis as an inpatient versus outpatient. In 2016 specifically, we observed that patients who started as an outpatient and received options education had higher Alb levels (3.5 mg/dL options education versus 3.4 mg/dL no education); for those starting dialysis as inpatients, Alb levels were 3.3 mg/dL and did not differ with options education or not. Concurrently, we observed that catheter use in patients starting dialysis as an outpatient was 13.8 percentage points lower in those with options education versus patients without education; in those starting dialysis as inpatients, the catheter use was 4.9 percentage points lower in with options education, compared to patients without education.

Conclusion

These findings indicate that options education before progression to ESRD is associated with dialysis patients achieving higher Alb levels and hemodialysis patients having lower catheter use in the incident dialysis period. Further analyses are warranted to confirm these results.

Funding

  • Commercial Support