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Abstract: PO1073

Implication of Trends in Timing of Dialysis Initiation on Population Incidence of ESRD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Parikh, Rishi V., Kaiser Permanente, Oakland, California, United States
  • Pravoverov, Leonid, Kaiser Permanente, Oakland, California, United States
  • Zheng, Sijie, Kaiser Permanente, Oakland, California, United States
  • Glidden, David V., University of California San Francisco, San Francisco, California, United States
  • Tan, Thida C., Kaiser Permanente, Oakland, California, United States
  • Go, Alan S., Kaiser Permanente, Oakland, California, United States
Background

In the past two decades, eGFR at start of chronic dialysis worldwide have changed notably. How changes over time in the likelihood of dialysis initiation at any given eGFR level impacts the population burden of ESRD has not been not well-defined.

Methods

We analyzed data from 2001-2015 in successive 3-year intervals among adult members of a large, integrated health care delivery system in Northern California who had ≥1 outpatient serum creatinine in the prior year. One-year risk of initiating chronic dialysis was delineated stratified by starting eGFR levels per 3-year cohort. To assess multivariable-adjusted temporal trends, we evaluated the significance of a 3-year cohort term in a logistic regression model adjusting for age, gender, race, and diabetes mellitus status. We then estimated a potential reduction in dialysis initiation in 2013-2015 using the relative difference between the standardized 1-year risks (95% CI) in 2001-2003 and 2013-2015.

Results

Among those with eGFR 16-17 mL/min/1.73m2 (N=2753), 14-15 mL/min/1.73m2 (N=2074), and 10-13 mL/min/1.73m2 (N=2655), the 1-year risk of initiating dialysis increased for every 3-year period by 11% (adjusted odds ratio [aOR] 1.11 [95% CI:1.03 to 1.21]), 11% (aOR 1.11 [1.03 to 1.20]) and 7% (aOR 1.07 [1.01 to 1.14]) respectively, adjusting for age, gender, race, and diabetes mellitus (Figure). We estimate that incidence of ESRD could have potentially been 16% (95% CI:13% to 18%) lower if there were no changes in system-level practice patterns or patient-related or other factors from 2001-2003 to 2013-2015.

Conclusion

Our data suggest that approximately two thirds of the target 25% relative reduction in new ESRD cases by 2030 called for in the White House AAKH initiative could potentially be achieved by changes in the timing of initiation of chronic dialysis.

FIGURE: Annual risk of initiating chronic dialysis by calendar year and index eGFR level, 2001-2015.

Funding

  • NIDDK Support