Kidney Week

Abstract: FR-PO788

Lower Rates of Hospital Admissions During a Fluid Management Quality Improvement (QI) Project Utilizing Relative Blood Volume Monitoring (RBV-M) - A Retrospective Database Analysis

Session Information

• Dialysis: Hospitalization and Mortality
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Balter, Paul, Nephrology Associates of Northern Illinois and Indiana (NANI), Oak Brook, Illinois, United States

Paul Balter,

• Rao, Panduranga S., University of Michigan Health System, Ann Arbor, Michigan, United States

Panduranga S. Rao,

• Li, Yisha, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States

Yisha Li,

• Mullon, Claudy, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States

Claudy Mullon,

• Kossmann, Robert J., Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States

Robert J. Kossmann,

• Ficociello, Linda, Fresenius Medical Care Renal Therapies Group, Waltham, Massachusetts, United States

Linda Ficociello,

Background

Hemodialysis (HD) patients experience high rates of hospitalization and mortality, especially in the first 90 days of dialysis. A clinic-wide fluid management QI project was conducted at 9 dialysis facilities utilizing RBV-M. The aim of this retrospective analysis was to assess hospital admissions among incident HD patients during the QI project compared to incident HD patients not participating in the QI project.

Methods

Incident patients in their first 90 days of HD were analyzed. The analysis included 3 periods: before the QI start (Pre-QI); during the QI project (QI); and following the end of the QI project (Post-QI). RBV-M was conducted using Crit-Line® monitors. Hazard ratios were modeled using all hospital admissions during the first 90 days of dialysis. Poisson regression was used to compare hospital days across 3 periods.

Results

1068 adult incident HD patients (Pre-QI: 501, QI: 376, Post QI: 191) who started HD between 2009 and 2017 were analyzed. There was a difference in hospital admission rates among the 3 periods (P=0.02). Compared to the QI period, the Pre-QI period had a 20% increased rate of hospitalization (HR= 1.2, 95%CI: [0.99,1.47]) and the Post-QI period had a 40% increased rate (HR= 1.4, 95%CI: [1.11,1.84]). Fewer hospital days were observed for the QI period (P=0.04) compared with the non-QI groups, with 5.84 (P=0.01) less hospital days per person-year (PPY) and 4.7 (P=0.12) less hospital days PPY compared with Pre-QI and Post-QI, respectively (Figure).

Conclusion

The use of RBV-M as part of a QI on fluid management was associated with a decreased rate of hospital admissions and fewer hospital days among incident HD patients during the first 90 days of dialysis.

Funding

• Commercial Support –