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Kidney Week

Abstract: PO0005

Regional Variation in Recovery of Kidney Function in Patients Requiring Maintenance Hemodialysis with Acute Tubular Necrosis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Kwong, Yuenting Diana, University of California San Francisco, San Francisco, California, United States
  • Johansen, Kirsten L., Hennepin Healthcare, Minneapolis, Minnesota, United States
  • McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
  • Grimes, Barbara A., University of California San Francisco, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Geographic variations in the likelihood of recovery of kidney function in ESKD attributed to acute tubular necrosis (ATN) has not been well established.

Methods

Using data from United States Renal Data System, we performed a retrospective cohort study of incident maintenance hemodialysis (HD) patients between 1/1/1996-12/31/2015 with ESKD attributed to ATN followed up to 1 year. Recovery of kidney function was defined as discontinuation of HD for at least 90 days and alive without the need for kidney transplantation during this period. We used Fine-Gray models to determine unadjusted and adjusted hazard of recovery while accounting for the competing risk of death.

Results

In 48,771 patients included for analysis, 30% recovered kidney function within 1 year. Most patients received HD within a 10-mile radius of their home. Recovery rates at 1 year were lowest in the northeast and highest in the south; lower in metropolitan compared to micropolitan/rural areas. Recovery of kidney function was less likely to occur with distance between patient and dialysis facilities in adjusted analysis.

Conclusion

Patients living in rural/micropolitan locations and receiving dialysis close to home had higher recovery rates. Studies examining regional differences in practice patterns are warranted.

PredictorN% RecoveredUnadjusted SHR [95% CI]Adjusted* SHR [95% CI]
US regionWest754831.0RefRef
Midwest1370129.30.94 [0.89-0.99]0.98 [0.93-1.04]
South1651933.91.07 [1.02-1.13]1.11 [1.05-1.17]
Northeast1100323.20.72 [0.68-0.76]0.81 [0.77-0.86]
PopulationMetropolitan3910829.1RefRef
Micropolitan/Rural873032.11.13 [1.08-1.18]1.10 [1.05-1.14]
Distance from home to HD facility0-<10 miles3385929.7RefRef
10-<25 miles977629.20.98 [0.94-1.02]0.96 [0.92-1.00]
≥25 miles522430.31.02 [0.97-1.10]0.93 [0.88-0.99]

Abbreviations: SHR = subdistribution hazard ratios, CI = Confidence Interval; * adjusted for age, sex, race, body mass index, initiation calendar period, and medical comorbidities (coronary artery disease, malignancy, heart failure, diabetes, hypertension, peripheral vascular disease, stroke, drug use, and smoking)

Funding

  • NIDDK Support