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Kidney Week

Abstract: FR-OR018

Incidence and Clinical Outcomes of Outpatient Dialysis for AKI Among Medicare Beneficiaries

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

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

As of January 1, 2017, Medicare Part B covers outpatient (OP) dialysis for acute kidney injury requiring dialysis (AKI-D). We analyzed Medicare claims to describe the incidence and clinical outcomes of beneficiaries initiating OP dialysis for AKI-D in 2017.

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 HCPCS code G0491. We excluded patients with Medicare claims history of OP dialysis for end-stage kidney disease (ESKD), dating to January 1, 2014. We followed patients from initiation of OP dialysis for AKI-D to the earliest of recovery of kidney function (≥2 weeks without OP dialysis for AKI-D), transition to ESKD (OP dialysis facility claim with condition code 71–74), death, or December 31, 2017.

Results

We identified 9634 Medicare beneficiaries undergoing OP dialysis for AKI-D and 9070 (94%) satisfying inclusion criteria. Mean age was 69.9 ± 11.2 years, 24% were age 20–64 years, 76% were white, 16% were black, 44% were female, and 27% were enrolled in Medicaid.

During follow-up, 3208 (35%) recovered kidney function, 3381 (37%) transitioned to ESKD, and 896 (10%) died. The cumulative incidence of these events is displayed. At 13 weeks after initiation of OP dialysis for AKI-D, 37% had recovered function, 36% had transitioned to ESKD, and 10% had died.

In 7485 patients who reached any endpoint, mean (median) days between first and last OP dialysis sessions were 45 (34) and mean (median) number of sessions was 17 (13).

Conclusion

Most Medicare beneficiaries who initiate OP dialysis for AKI-D recover kidney function or transition to ESKD within 3 months. Long-term follow-up of those who recover function is needed.