Abstract: SA-PO848
Predicted Risk of Renal Replacement Therapy at Time of Referral for Arteriovenous Fistula Placement in CKD
Session Information
- CKD: Socioeconomic Context and Mobile Apps
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Park, Ken J., Kaiser Permanente, Salem, Oregon, United States
- Benuzillo, Jose G., Kaiser Permanente, Salem, Oregon, United States
- Keast, Erin, Kaiser Permanente Center for Health Research, Portland, Oregon, United States
- Thorp, Micah L., Northwest Permanente, Portland, Oregon, United States
- Mosen, David, Kaiser Permanente Northwest, Portland, Oregon, United States
- Johnson, Eric S., Northwest Permanente, Portland, Oregon, United States
Background
The complexity in predicting which and when patients with chronic kidney disease (CKD) will progress to renal replacement therapy (RRT) contributes to 80% of patients starting hemodialysis without a functioning permanent access. This has been associated with higher mortality, morbidity, and cost. A prediction model developed at Kaiser Permanente Northwest may help guide timing of AVF placement.
Methods
398 CKD stage 4 patients followed by nephrology were classified into AVF referral group (n = 199) and non AVF referral group (n = 199). The non-referral group was randomly selected and matched 1:1 on age, gender, and eGFR. Patients were followed for up to two years and censored if they died or discontinued coverage. Survival analyses were performed for overall hemodialysis initiation.
Results
The average age was 68.5 years in the AVF referral group and 68.1 years in the non AVF referral group. The mean eGFR among the AVF referral group was 16.8 mL/min and 17.2 ml/min in the non AVF referral group. The average 2-year predicted risk of progression to RRT was 47.7% in the AVF referral patients and 44.1% in the matched controls.
Hemodialysis initiation occurred at a significantly higher rate in the AVF referral group than in the non AVF referral group (43.7% vs. 23.6%, HR = 1.9, p < 0.001). The AVF referral group was stratified into quartiles based on predicted risk of progression to RRT. The lowest quartile (average risk 17.6%) had a 78% lower risk of hemodialysis initiation than the highest quartile (average risk 84.3%); HR = 0.22, p < 0.001.
Conclusion
In patients with CKD stage 4, a computer-generated risk score identified a subgroup of AVF referred patients with a low predicted risk to RRT that may have been referred too early.
Kaplan-Meier curve of dialysis free survival by 2 years risk for renal replacement therapy divided into quartiles