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Abstract: FR-OR003

Increased Hemodialysis Frequency Is Associated with Improved Clinical Outcomes among Patients in Skilled Nursing Facilities

Session Information

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Hocking, Kathy, Affiliated Dialysis Centers, Glen Ellyn, Illinois, United States
  • Markovich, Susan, Affiliated Dialysis Centers, Glen Ellyn, Illinois, United States
  • Vavrinchik, Scott, Affiliated Dialysis Centers, Glen Ellyn, Illinois, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

In light of hemodynamic instability and frailty, dialysis patients who reside in a skilled nursing facility (SNF), either for short-term rehabilitation or long-term custodial care, may benefit from on-site, frequent hemodialysis (HD). We assessed whether increased HD frequency was associated with risks of death and hospital admission among SNF patients receiving care from a single dialysis provider in the Chicago area.

Methods

We assessed Medicare Parts A and B claims in 2011-2015 to identify HD patients at Affiliated Dialysis Centers (ADC). For each patient-week in 2011-2015, we tallied the number of HD sessions at ADC. We constructed an outcome-exposure model that measured associations of all-cause mortality, all-cause hospital admission (HA), and cause-specific (cardiovascular disease, infection, and other morbidity) HA risks during one calendar week with mean HD frequency during the preceding two calendar weeks, with frequency categorized as ≥4.5 vs. 2.5-4.4 HD sessions/week. We fit logistic generalized estimating equations, with adjustment for age, race, sex, primary cause of end-stage renal disease (ESRD), duration of ESRD, vascular access type, and calendar time.

Results

We identified 3619 unique patients and 78,047 patient-weeks. Mean age was 69.0 years; 59% and 34% of patients were white and black, respectively; 49% were female; and 53% dialyzed with a central venous catheter. Between 2011 and 2015, the percentage of two-week intervals with ≥4.5 HD sessions/week increased monotonically, from 9% in 2011 to 45% in 2015. We observed 641 deaths. The adjusted mortality risk ratio for ≥4.5 vs. 2.5-4.4 HD sessions/week was 0.66 (95% confidence interval, 0.52-0.83). The adjusted all-cause HA risk ratio for ≥4.5 vs. 2.5-4.4 HD sessions/week was 0.91 (0.81-1.02). Corresponding cause-specific HA risk ratios were 0.77 (0.62-0.97), 1.05 (0.88-1.24), and 0.86 (0.74-1.00) for cardiovascular disease, infection, and other morbidity, respectively. For all HAs excluding those attributable to infection, the adjusted risk ratio for ≥4.5 vs. 2.5-4.4 HD sessions/week was 0.83 (0.73-0.95).

Conclusion

In a large study of on-site HD in the SNF setting, increased HD frequency was associated with significantly lower risks of death and all hospital admissions excluding those attributable to infection.

Funding

  • Commercial Support