Abstract: SA-PO836

The Association of Comorbidity and Nephrology Care with Mortality in Incident Dialysis Patients: A Population-Based Study

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Chiu, Yiwen, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  • Lin, Ming-Yen, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  • Jian, Feng-Xuan, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  • Wu, Ping-hsun, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  • Hwang, Shang-Jyh, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Background

Nephrology care in late CKD can improve the survival after dialysis, how the morbidity affects this effectiveness remains unclear.

Methods

We conducted a retrospective cohort study to include incident patient with dialysis ≥ 3 months by using Taiwan National Health Insurance Research Databases from 2004 through 2012. Incident patients were included from 2007 through 2011 and their comorbidities were identified within three years before dialysis start. Nephrology care was evaluated by cumulative care (total nephrology visits in 3 years before dialysis), critical period care (at least one nephrology visit in 6 months before dialysis), and consistent critical period care (nephrology visits more than 3 in the 6 months before dialysis). One-year mortality risks after dialysis start were evaluated in all study subjects as well as cohorts stratified by comorbidity number by various nephrology cares in late CKD.

Results

We included total 44,698 (mean age 63.3±14.2, male 51.9%) and identified 9,600 (21.5%, mean age 67.8±11.4, male 47.6%) patients with multi-morbidity(≥ 3 diseases). 5428 patients(12.1%, mean age 61.2±16.2, male 56.1%) had no any nephrology visit, and only one half had nephrology visits more than ten times in 3 years before dialysis. After adjusted age, sex, socioeconomic status, living area, urbanization and comorbidity number, higher cumulative care (> 10 times), having critical period care, and consistent critical period care were associated with a lower mortality risk. Regular care in other specialties didn’t have such association. In addition, the increase of comorbidities didn't change the pattern of significant association. (Table1)

Conclusion

Regular nephrology care should be highlighted in late CKD no matter how the burden of comorbidities is.

Table1
Expressed as:
Adjusted HR(95%CI)
All
N=44,698
1 comorbidity
N=15,431
2 comorbidity
N=12,118
≥ 3 comorbidity
N=9,600
cumulative care
(>10 times vs. 0)
0.67(0.59-0.78)0.72(0.56-0.94)0.68(0.52-0.89)0.74(0.58-0.96)
critical period care
(yes vs. no)
0.88(0.78-0.99)0.92(0.74-1.14)0.83(0.67-1.04)0.85(0.69-1.03)
consistent critical period care
(yes vs. no)
0.75(0.69-0.82)0.74(0.63-0.87)0.79(0.67-0.93)0.72(0.62-0.85)

p<0.05 shown in bold

Funding

  • Government Support - Non-U.S.