Kidney Week

Abstract: TH-PO491

Assessment of Comorbidities and Pre-Dialysis Adverse Outcomes among Incident Renal Replacement Therapy Patients

Session Information

• CKD: Epidemiology, Outcomes - Cardiovascular - I
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

• Lee, MinJeong, Ajou University School of Medicine, Suwon, Korea (the Republic of)

MinJeong Lee,

• Park, Inwhee, Ajou University School of Medicine, Suwon, Korea (the Republic of)

Inwhee Park,

• Kim, Heungsoo, Ajou University School of Medicine, Suwon, Korea (the Republic of)

Heungsoo Kim,

• Shin, Gyu Tae, Ajou University School of Medicine, Suwon, Korea (the Republic of)

Gyu Tae Shin,

• Jeong, Jong Cheol, Ajou University School of Medicine, Suwon, Korea (the Republic of)

Jong Cheol Jeong,

Background

Several observational studies have shown that initiation of RRT at high estimated glomerular filtration rate(eGFR) was associated with poorer post-RRT patient survival. But, most of previous studies have been based on registry data by patients who survived to initiate RRT. Therefore, we investigated pre-dialysis morbidity and adverse outcome preceding initiation of dialysis as clinical outcomes and the association of pre-dialysis clinical outcomes with eGFR at RRT initiation.

Methods

EMR of incident dialysis patients who started maintenance dialysis between Jan 2010 and Dec 2015 were reviewed. Patients with eGFR≤20ml/min were enrolled. Comorbidity indices were calculated for each patient based on the comorbidity at the enrolled time. Patients were classified as ‘safe RRT’ group vs ‘urgent RRT’ group, defined as the patients who started RRT from urgent indication such as uremic encephalopathy, uremic pericarditis, pulmonary edema, or serum potassium≥7.0mEq/L.

Results

Among total 1,044 patients, mean eGFR at RRT initiation was 6.7±4.3ml/min/1.73m². Mean eGFR at RRT initiation was higher in larger comorbidity burdens(Fig1). Urgent RRT group had higher modified Charlson score than safe RRT group(4.9±2.1 vs 3.5±2.3, p< 0.001).
During pre-dialysis period from enroll time to RRT initiation, patients with higher comorbidities experienced more cardiovascular adverse outcome such as MI or angina, and more infection event requiring hospitalization(Fig2).

Conclusion

Patients with larger comorbidities experienced more adverse events during pre-RRT period. Timing of RRT initiation should be individualized considering burden of comorbidities.

Fig1. eGFR at Dialysis Initiation

Figure 2. Pre-Dialysis Adverse Outcomes