Kidney Week

Abstract: TH-PO551

Factors Associated with Non-Conservative Treatment of Stage 5 CKD

Session Information

• CKD: Health Services, Disparities, Prevention
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 307 CKD: Health Services, Disparities, Prevention

Authors

• Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States

Robert N. Foley,

• Reule, Scott, University of Minnesota, Minneapolis, Minnesota, United States

Scott Reule,

Background

Quality of death and patient autonomy are prominent public health issues. In this regard, the decision to institute dialysis in patients with non-dialysis Stage 5 chronic kidney disease (CKD₅, GFR ≤ 15) is often difficult, because comorbid illnesses are the rule, and survival and quality of life with maintenance dialysis are often poor. Hence, we set out to examine factors associated with choosing to institute maintenance dialysis, as opposed to conservative management, in older adults.

Methods

We used the (US) Medicare 5% CKD random sample to identify 15,884 patients with diagnostic claims for CKD₅ between 2006 and 2011, with at least 6 months of prior Parts A and B Medicare insurance. Hospital admission codes in the prior 6 months were used to characterize comorbidity. Time to renal replacement therapy (RRT) was the primary outcome.

Results

The mean age of the study population at diagnosis of CKD₅ was 76 years. Mean follow-up was 2.8 years and 51.3% opted to begin RRT. In models that adjusted for age, demography and comorbid illnesses, adjusted hazards ratios (AHR) for RRT were > 1 (P < 0.05) for African American race (AHR 1.25 Vs. white), Native American race (AHR 1.38) and cardiac failure (AHR 1.38). RRT was less likely with older age (AHR 0.73 for 70-79, 0.63 for 80-89 and 0.44 for ≥ 90 [Vs. < 70 years]), female sex (AHR 0.89) and malignancy (AHR 0.92).

Conclusion

These findings suggest that a substantial proportion of Medicare patients with GFR ≤ 15 decline the option of RRT. Age, sex, race and comorbidity profiles influence this choice.