Abstract: SA-PO1050
Mortality and Morbidity Among African American Patients with Sickle Cell Disease and ESRD Initiating Dialysis
Session Information
- Hemodialysis and Frequent Dialysis - VI
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Olaniran, Kabir O., Massachusetts General Hospital, Boston, Massachusetts, United States
- Nigwekar, Sagar U., Massachusetts General Hospital, Boston, Massachusetts, United States
- Eneanya, Nwamaka D., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Zhao, Sophia, Massachusetts General Hospital, Boston, Massachusetts, United States
- Ofsthun, Norma J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Dalrymple, Lorien S., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Thadhani, Ravi I., Cedars-Sinai, Los Angeles, California, United States
Background
High rates of mortality have been described in sickle cell disease patients with end-stage renal disease (SCD-ESRD), however, risk factors for mortality and associated morbidity have not been elucidated. We examined vascular access failure (VAF), hospitalization and mortality among a cohort of adults with SCD-ESRD.
Methods
We identified adult, black patients with SCD who initiated peritoneal or in-center hemodialysis (PD or ICHD) dialysis in Fresenius Kidney Care clinics between 2000-2014 with up to 10 years of follow up. Patients with SCD were matched 1:3 to a reference population of black patients receiving PD or ICHD without SCD or sickle cell trait using age, sex, year of dialysis initiation and end-stage renal disease (ESRD) network. Multivariable Cox proportional hazards models were used to examine time to first VAF, first hospitalization, and 10-year mortality. Unadjusted mortality rate differences were estimated between vintage categories 2000-2004 and 2010-2014.
Results
We identified 504 SCD-ESRD patients and 1,425 matched reference patients. The mean age was 47±14 years, 49% were female, 95% were receiving ICHD and median follow up was 2 (IQR 1-4) years. SCD-ESRD was associated with a higher risk of VAF (adjusted HR 1.23; 95% CI 1.03-1.48), hospitalization (adjusted HR 1.60; 95% CI 1.42-1.80) and 10-year mortality (adjusted HR 1.58; 95% CI 1.31-1.96). Univariate analysis produced similar results. Hemoglobin < 8g/dl, higher weekly epoetin doses, higher ultrafiltration rates, dialysis catheter use, and low serum albumin were associated with higher mortality in SCD-ESRD. Changes in 10-year mortality rates in SCD-ESRD were non-significant between 2000-2004 and 2010-2014 (203 to 145/1,000 person-years, p=0.06) in contrast to a downward trend in mortality in the reference in the same period (109 to 57/1,000 person-years, p<0.01).
Conclusion
SCD-ESRD was associated with a higher risk of VAF, hospitalization and mortality. Although mortality rates decreased in the SCD-ESRD population during the timeframe of observation, rates did not decline to the same extent observed in the reference population. Prospective studies are needed to better characterize risk factors for mortality and address target parameters to improve outcomes in SCD-ESRD.