Abstract: TH-PO1103
Sex and Racial Differences in Pre-Dialysis Hospitalization in Incident ESRD Patients
Session Information
- CKD: Clinical, Outcomes, Trials - I
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
- Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
- Christianson, Annette, University of Cincinnati, Cincinnati, Ohio, United States
- Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
- Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background
Pre-dialysis hospitalization is an independent predictor of mortality, and significant contributor to health care costs in patients with end stage renal disease. Sex and racial differences in the pre-dialysis hospitalizations has not been studied for incident dialysis patients.
Methods
We evaluated 165,452 adult patients who initiated dialysis between 1/1/2010 and 12/31/2014 from the United States Renal Data System with linked claims for Medicare Part A and Part B or Medicare Primary Other as the primary payer for the entire two years prior to dialysis initiation. Using case-mix adjusted logistic regression models, we examined the impact of race and sex on the two year pre-dialysis hospitalization as the primary outcome identified using ICD-9 codes.
Results
Mean age was 73 ± 11 years. In the study sample, 54.3% were men. 65% were Whites, 21.6% were Blacks, 8.9% were Hispanics, 3.5% were Asians, and 0.9% were Native Americans. Overall, 77% of patients had at least one pre-dialysis hospitalization. Among the causes of pre-dialysis hospitalization, 28.6% of patients experienced cardiovascular hospitalization, 12.4% had infection hospitalization, 11.5% had both cardiovascular and infection hospitalization and 24.5% had neither cardiovascular nor infection hospitalization. Overall, one-year all-cause mortality was 30.7%. Women had higher odds of pre-dialysis hospitalization as compared to men (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.14-1.20]). In adjusted analyses, as compared to Whites patients, odds of pre-dialysis hospitalization was lower among Asians (OR, 0.55; 95% CI, 0.52-0.59]), and Hispanics (OR, 0.80; CI, 0.77-0.84); and was not statistically significant for Black patients or Native Americans.
Conclusion
Among dialysis patients, women have 17% higher odds of pre-dialysis hospitalization as compared to men. As compared to White patients, Asians have 45% lower odds and Hispanics have 20% lower odds of pre-dialysis hospitalizations. Process of care and biological factors need to be explored further to understand the reasons behind these disparities associated with pre-dialysis hospitalization.