Kidney Week

Abstract: TH-OR099

Impact of Rescheduling a Missed Hemodialysis Treatment on Clinical Outcomes

Session Information

• Outcomes and Trends in Dialysis
  October 25, 2018 | Location: 2, San Diego Convention Center
  Abstract Time: 06:06 PM - 06:18 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States

Dena E. Cohen, PhD

Dena E. Cohen is a medical writer with DaVita Clinical Research. She holds a bachelor's degree in biology from the Massachusetts Institute of Technology, and a PhD in genetics from Harvard University.

• Gray, Kathryn S., DaVita Clinical Research, Minneapolis, Minnesota, United States

Kathryn S. Gray,

• Colson, Carey, DaVita Clinical Research, Minneapolis, Minnesota, United States

Carey Colson,

• Van Wyck, David B., DaVita Institute for Patient Safety, Denver, Colorado, United States

David B. Van Wyck,

• Tentori, Francesca, DaVita Clinical Research, Minneapolis, Minnesota, United States

Francesca Tentori,

• Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli,

Background

Among patients treated with hemodialysis (HD), a missed treatment is associated with elevated hospitalization risk in the subsequent 30 days. It is not known whether attending a rescheduled treatment on the following day ameliorates this risk.

Methods

This retrospective study used electronic health records and 2014 USRDS claims merged via direct linkage. Eligible patients were adults receiving HD on a Monday/Wednesday/Friday schedule who, as of index, had dialysis vintage ≥90 days, available Medicare A & B claims, and had not missed a treatment for any reason in the 30 days prior to index. For each of 12 index dates, patients were classified based on attending treatment; those who did not were classified as “rescheduled” or “missed” based on whether or not they dialyzed the following day. In separate analyses, "rescheduled" and "missed” patients were each matched (1:5) to patients who attended based on index day of week and propensity score. Hospitalization was considered over the subsequent 7 and 30 days, or until censoring, and compared using generalized linear models.

Results

Prior to matching, patients who missed or rescheduled treatment were of younger age and dialysis vintage than those who attended. All characteristics were balanced after matching. Compared to attending (N=20,725), a missed treatment (N=4145) was associated with a 100% higher rate of hospitalization in the subsequent 7 days, and a 39% higher rate over 30 days. Attending a rescheduled treatment on the day after a missed treatment (N=2308) was associated with a 49% higher rate of hospitalization in the subsequent 7 days, and a 31% higher rate over 30 days, versus attending (N=11,540).

Conclusion

Rescheduling treatment attenuated but did not fully mitigate the hospitalization risk imposed by a missed treatment.

Funding

• Commercial Support – This was a research project conducted by the DaVita Institute for Patient Safety and supported by DaVita Kidney Care.