Kidney Week

Abstract: TH-PO1042

Coordination of Pharmaceutical Care in Dialysis Patients Is Associated with Lower Mortality and Hospital Admission Rates

Session Information

• Mineral Disease: Ca/Mg/PO4
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

• 1201 Mineral Disease: Ca/Mg/PO4

Authors

• Rosen, Sophia, Fresenius Medical Care, Waltham, Massachusetts, United States

Sophia Rosen,

• Reviriego-Mendoza, Marta, Fresenius Medical Care, Waltham, Massachusetts, United States

Marta Reviriego-Mendoza,

• Clary, Savannah Roberts, FreseniusRx, Franklin, Tennessee, United States

Savannah Roberts Clary,

• Chaudhuri, Sheetal, Fresenius Medical Care, Waltham, Massachusetts, United States

Sheetal Chaudhuri,

• Dias, Michelle, FreseniusRx, Franklin, Tennessee, United States

Michelle Dias,

• Larkin, John W., Fresenius Medical Care, Waltham, Massachusetts, United States

John W. Larkin,

• Usvyat, Len A., Fresenius Medical Care, Waltham, Massachusetts, United States

Len A. Usvyat,

• Ketchersid, Terry L., Fresenius Medical Care, Waltham, Massachusetts, United States

Terry L. Ketchersid,

• Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States

Franklin W. Maddux,

Background

It is estimated in the literature that >50% of ESRD patients do not take their phosphate binders as prescribed. The renal pharmacy FreseniusRx provides coordinated mineral and bone disorder (MBD) medication delivery and adherence support for enrolled patients. We investigated whether coordinated MBD pharmaceutical care is associated with improvements in hospital admission and mortality rates in dialysis patients.

Methods

We included data from hemodialysis patients in the network of Fresenius Medical Care North America clinics who were first enrolled into FreseniusRx pharmacy in January-February of 2016. This analysis utilized data on patients before and up to 9 months after pharmacy enrollment. We identified control patients not enrolled in the pharmacy by nearest neighbor 1:1 matching on the logit of the propensity score for demographics, comorbidities, state, insurance type, as well as, baseline lab values, vintage, access, hospitalization rates and other parameters. We compared hospital admission and mortality rates in 3, 6, and 9 months after enrollment.

Results

We analyzed data on 7116 patients (3558 in Rx and 3558 matched patients not in Rx). Rx patients had lower hospital admission rates per patient year (Rx vs non-Rx at 3, 6, and 9 months: 1.41 vs 1.54, 1.52 vs 1.62, 1.49 vs 1.60; p=0.03, p=0.09 and p=0.065 based on Poisson model). Mortality rates were also lower (HR for Rx vs non-Rx at 3, 6, and 9 months: 1.4, 1.4 and 1.3; p=0.03, p=0.004 and p=0.003 based on Cox model).

Conclusion

Coordinated pharmaceutical care is associated with lower hospital admission and mortality rates in the hemodialysis patient population. Further analyses are needed to understand what elements of this coordinated care are associated with improvements.

Funding

• Commercial Support – Fresenius