Abstract: SA-PO1016
Association of Race/Ethnicity and Pre-ESKD Disease Duration with Subsequent Dialysis Mortality in US Veterans with ESKD
Session Information
- Hemodialysis and Frequent Dialysis - V
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
- Yan, Guofen, University of Virginia, Charlottesville, Virginia, United States
- Nee, Robert, Walter Reed National Military Medical Center, Vienna, Virginia, United States
- Norris, Keith C., UCLA, Marina Del Rey, California, United States
- Greene, Tom, University of Utah, Salt Lake City, Utah, United States
- Oliver, Mohammed Norman, Virginia Department of Health, Richmond, Virginia, United States
- Yu, Wei, University of Virginia, Charlottesville, Virginia, United States
- Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
Background
The mortality rate of patients undergoing dialysis is exceptionally high. The role of disease duration before end-stage kidney disease (ESKD) on subsequent dialysis mortality is not clear due to lack of data on the accurate time of CKD onset. Using a national incident CKD cohort we recently constructed, we examined the association between disease duration prior to ESKD and dialysis mortality by race/ethnicity.
Methods
We first identified all subjects with new onset CKD (stage 3-5) in the U.S. Veteran Affairs database since 4/1/2002. CKD onset was determined by two eGFRs (based on CKD-EPI equation) <60 mL/min/1.73 m2 at >90 days apart. We then extracted the subset of patients who started dialysis with at least one year of follow-up until 5/1/2016. Disease duration was determined as time from the date of CKD onset to the date of first dialysis. Hazard ratios for death were examined for duration of <1 year, 1-3 years, and 3-5 years as compared to duration of ≥5 years for each race/ethnicity, adjusted for covariates including age at ESKD onset, gender, last eGFR prior to first dialysis, and major comorbid conditions such as diabetes, hypertension, and cardiovascular diseases.
Results
Of 28,129 incident dialysis patients included, 8,874 were Black, 1,892 Hispanic, and 17,363 White. The median duration from CKD onset to ESKD onset was 2.7 years for Blacks, 2.8 for Hispanics, and 3.3 for Whites. More than half of Blacks (55%) and Hispanics (53%) developed ESKD within 3 years of CKD onset, compared to 46% of Whites. After adjustments, shorter disease duration before ESKD was significantly associated with greater mortality on dialysis for Blacks, but not for Whites and Hispanics (Table). P value for testing the differential associations across three racial/ethnic groups was 0.003.
Conclusion
Our findings suggest the association of disease duration before ESKD and dialysis mortality differed by race/ethnicity, prompting the need to delineate the factors responsible for these differential associations.
Adjusted hazard ratios (HR) by race/ethnicity
| Black | Hispanic | White | |||||||
| Pre-ESKD duration (years) | % patients | HR (95% CI) | P value | % patients | HR (95% CI) | P value | % patients | HR (95% CI) | P value |
| <1 | 19.6 | 1.32 (1.19-1.46) | <0.001 | 20.3 | 1.05 (0.86-1.27) | 0.64 | 15.7 | 1.01 (0.95-1.07) | 0.78 |
| 1-3 | 34.9 | 1.15 (1.04-1.25) | 0.004 | 32.9 | 1.01 (0.85-1.19) | 0.93 | 30.1 | 0.96 (0.92-1.01 ) | 0.15 |
| 3-5 | 23.2 | 1.15 (1.04-1.26) | 0.006 | 22.0 | 0.93 (0.77-1.11) | 0.42 | 24.2 | 0.99 (0.94-1.04) | 0.58 |
| ≥5 | 22.3 | 1 | 24.8 | 1 | 30.0 | ||||
Funding
- NIDDK Support