Abstract: SA-PO1101
Kidney Disease Education: Marker or Effector of Improved Vascular Access Outcomes
Session Information
- Vascular Access - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Shukla, Ashutosh M., University of Florida, Gainesville, Florida, United States
- Ruchi, Rupam, University of Florida, Gainesville, Florida, United States
- Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States
- Ozrazgat-Baslanti, Tezcan, University of Florida, Gainesville, Florida, United States
- Mohandas, Rajesh, University of Florida, Gainesville, Florida, United States
- Segal, Mark S., University of Florida, Gainesville, Florida, United States
Background
Despite 2 large systemwide initiatives, vascular access outcomes for US incident end-stage renal disease (ESRD) patients continue to be suboptimal. Pre-ESRD renal care is the strongest predictor of vascular access readiness. Studies have shown that Kidney Disease Education (KDE) improves the quality of pre-ESRD care
Methods
We examined the impact of KDE on the incident vascular access rates among US adult ESRD Medicare beneficiaries since the implementation of CMS-KDE policy (2010-2014). Co-primary outcomes were incident fistula (AVF) rates and composite of incident fistula and/or graft rates (AVF±AVG). Secondary outcomes were composite maturing AVF±AVG, and any form of non-catheter vascular access (AVF±AVG in use or maturing). Multivariate analyses were performed in 4 progressive models (model1: KDE, model2: model1+socio-demographic adjustments, model3: model2+comorbidity and functional status adjustments, and model4: model3+adjustments for pre-ESRD renal care)
Results
Of the 309743 patients with their first dialysis as hemodialysis between 2010-14, 2916 (<1%) had at least one KDE during pre-ESRD (KDE cohort) whereas 306827 had no KDE (non-KDE cohort). All primary and secondary vascular access outcomes were significantly superior among the KDE cohort and the effect was maintained across all progressive multivariate models (Table). Stratified analyses further confirmed that the positive associations of KDE to vascular access did not dissipate even after accounting for pre-ESRD renal care, which has the strongest association with the vascular access outcomes (Table 2)
Conclusion
Pre-ESRD KDE is associated with improved quality of CKD care as judged by the incident vascular access outcomes. The positive effects of KDE is maintained across all baseline socio-demographic, comorbidity, and functional status variables, and is additive to the pre-ESRD renal care. Wider use of pre-ESRD KDE across advanced CKD patients may improve incident vascular access outcomes among US ESRD patients
Incident Vascular Access Outcomes among the Study Cohorts
| Outcomes N (%) | KDE Cohort (N = 2,916) | Non-KDE Cohort (N = 306, 827) | Impact of KDE on the Odds of Achieving the Incident Vascular Access Outcomes in progressive multivariate models | |||
| Model 1 OR (95% CI) | Model 2 OR (95% CI) | Model 3 OR (95% CI) | Model 4 OR (95% CI) | |||
| AVF Used at Incident ESRD | 864 (29.63) | 44,511 (14.51) | 2.59 (2.39-2.81) | 2.59 (2.39-2.81) | 2.46 (2.26-2.68) | 1.79 (1.64-1.96) |
| AVF ± AVG used at Incident ESRD | 1,014 (34.77) | 52,708 (17.18) | 2.57 (2.38-2.78) | 2.53 (2.34-2.73) | 2.41 (2.23-2.62) | 1.78 (1.64-1.94) |
| CVC used, AVF ± AVG Maturing at Incident ESRD | 724 (24.83) | 57,841 (18.85) | 2.09 (1.90-2.29) | 2.18 (1.98-2.39) | 2.10 (1.91 2.32) | 1.76 (1.59-1.94) |
| Any form of Vascular Access present, AVF ± AVG used or maturing present | 1,738 (59.6) | 110,548 (36.03) | 2.62 (2.43-2.82) | 2.68 (2.48-2.88) | 2.59 (2.39-2.80) | 2.01 (1.85-2.18) |
OR: Odds Ratio, CI: confidence interval