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Kidney Week

Abstract: FR-OR017

Outcomes of AKI Patients Receiving Dialysis in ESRD Facilities

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Segal, Jonathan H., University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Dahlerus, Claudia, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Chen, Shu, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Shearon, Tempie H., University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Pearson, Aaron, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Yating, Sun, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Sardone, Jennifer, University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Messana, J. M., University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
Background

Medicare beneficiaries with Acute Kidney Injury (AKI) have received dialysis in outpatient end stage renal disease (ESRD) facilities since 2017 as a result of a CMS policy change allowing payment for dialysis services provided to AKI patients. Outcomes of AKI patients relative to ESRD patients have not been reported.

Methods

AKI patients were identified from 2017 Medicare claims with at least one bill type 072x with condition code 84 (Dialysis for AKI), CPT G0491 (Dialysis for AKI without ESRD) or a select group of ICD-10 codes. We determined patient transition to ESRD from CROWNWeb and other sources; vital status was obtained from the Medicare Enrollment Database. Patients were followed through 3/31/18. We used Cox proportional hazards modeling to compare survival between AKI and non-AKI Medicare incident ESRD patients.

Results

10,717 of 399,936 (2.7%) patients on dialysis had at least one AKI claim. AKI patients were more likely to be white (72% v. 47%) and age 60+ (82% v. 61%) than ESRD patients. Overall 64% of AKI patients developed ESRD, 13% died without developing ESRD, 17% were alive without ESRD, and 6.1% were lost to follow up. Hospital based facilities had a larger proportion of AKI claims relative to free standing facilities (mean 1.9% v. 0.7% of all dialysis claims). After adjustment for age, race, sex, and ethnicity, AKI patients had a 27% higher mortality risk compared to incident ESRD patients (HR 1.27, p<0.0001).

Conclusion

Patients with AKI represented a small proportion of patients in ESRD facilities in 2017. Almost two-thirds developed ESRD during our limited follow-up. Mortality in the AKI population was higher compared to incident ESRD patients suggesting additional investigation is needed to understand the differences and monitor their outcomes.

Funding

  • Other U.S. Government Support