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Kidney Week

Abstract: FR-PO007

Epidemiology of Hospitalization Preceding Initiation of Outpatient Dialysis for AKI Among Medicare Beneficiaries

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Weinhandl, Eric D., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Dalrymple, Lorien S., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Little is known about hospital admissions preceding initiation of outpatient (OP) dialysis for acute kidney injury requiring dialysis (AKI-D), which presumably represent transitions of AKI-D care from inpatient to outpatient settings. We examined Medicare claims to assess hospitalizations preceding the initiation of OP dialysis for AKI-D.

Methods

We analyzed the 100% sample of institutional claims in 2014–2017 Medicare Limited Data Sets. To identify initiation of OP dialysis for AKI-D, we located the first OP dialysis facility claim in 2017 with condition code 84 and Healthcare Common Procedure Coding System code G0491. We excluded any patients with Medicare claims history of OP dialysis indicated for end-stage kidney disease, dating to January 1, 2014. We retained the subset of patients with Medicare coverage during the 6 calendar months preceding the month of initiation of OP dialysis for AKI-D. We then analyzed hospitalization claims, including ICD-10 diagnosis codes.

Results

The cohort comprised 8500 patients. Mean age was 70.5 ± 11.0 years, 77% were white, and 44% were female. During the 6 months preceding the initiation of OP dialysis for AKI-D, 8209 (97%) patients were hospitalized, with cumulative totals of 1.9 admissions and 27 hospitalized days.
Regarding the last hospitalization preceding initiation of OP dialysis for AKI-D, mean (median) length of stay was 20 (15) days; 29% were discharged home under self-care, 25% to home health care, 42% to a skilled nursing facility, and 3% to intermediate care settings. The number of days between hospital discharge and initiation of OP dialysis for AKI-D was ≤1 in 34% of patients, 2–3 in 52%, 4–7 in 8%, and >7 in 6%.
During the last hospitalization preceding initiation of OP dialysis for AKI-D, chronic kidney disease (CKD) was documented in 86% of admissions, diabetes in 59%, heart failure in 53%, and atrial fibrillation in 34%. Clinical events included acute respiratory failure in 29% of admissions and sepsis in 20%.

Conclusion

In Medicare beneficiaries, hospitalizations preceding initiation of OP dialysis for AKI-D are typically long and often complex, with 1 in 5 experiencing sepsis and 1 in 3 acute respiratory failure. CKD is common in this population, as is concurrent care in a skilled nursing facility at initiation of OP dialysis for AKI-D.