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Kidney Week

Abstract: SA-PO736

Outcomes Among Those Receiving Veterans Affairs (VA) Insurance in the United States

Session Information

  • Geriatric Nephrology
    October 27, 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

  • Reule, Scott, University of Minnesota, Minneapolis , Minnesota, United States
  • Sexton, Donal J., The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin., Dublin, Ireland
  • Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States
Background

Recent policy initiatives seek to address barriers to subspecialty care for veterans based on clinic wait times and geographic distance through a mechanism of outsourcing to community providers. Due to limited Veterans Health Care Service (VAHCS) capacity to provide care to those with end-stage kidney disease (ESKD), we set out to describe characteristics, trends and important healthcare outcomes among Veterans Affairs (VA) insured patients from 1995-2012.

Methods

United States Renal Data System (USRDS) combined with United States (US) census data was used to compare baseline characteristics and adjusted outcomes for mortality and transplantation among those initiating maintenance renal replacement therapy receiving VA insurance.

Results

A total of 32,035 VA insured patients initiated maintenance RRT over the time period of 1995-2012 with follow up extending to June 30th, 2014. Compared to 1995-1996, overall incidence of RRT initiation increased in a linear fashion (IR 1.94, 2011-2012). Subgroups experiencing the greatest increase included those > 65 years of age (IR 2.16), female (IR 2.54), and white patients (IR 2.35). Compared to 1995 - 2004, VA insured patients initiating between 2005 – 2012 were more likely to be 40-64 years of age (51.3% vs. 50%), > 65 years of age (47.3% vs. 46.4%), and less likely to be female (8.4% vs. 9.4%) or Hispanic (8.7% vs. 10.9%). No difference in mortality hazard was observed in demography adjusted models (AHR 1.03; CI 0.99 – 1.08), however, VA insured patients were more likely to be listed for (AHR 1.23; CI 1.10 – 1.37) and to receive kidney transplantation (AHR 1.19; CI 1.03 – 1.38).

Conclusion

In conclusion, VA insured patients initiating RRT has increased significantly in recent years. While older patients are increasingly likely to have initiated RRT in recent years, the finding of no mortality difference in adjusted models is reassuring.

Funding

  • Other NIH Support