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Abstract: PO1111

Comparative Mortality of ESKD from Nephrolithiasis or Urolithiasis in the United States

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yan, Jingyin, Baylor College of Medicine Margaret M and Albert B Alkek Department of Medicine, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine Margaret M and Albert B Alkek Department of Medicine, Houston, Texas, United States
  • Niu, Jingbo, Baylor College of Medicine Margaret M and Albert B Alkek Department of Medicine, Houston, Texas, United States
Background

Patient with nephro-/urolithiasis (NL/UL), when compared with patients without kidney stone disease, experience higher rates of adverse health outcomes, including increased mortality, cardiovascular morbidity, and progressive kidney disease. Little is known about the epidemiology and outcomes of patients who reach end-stage kidney disease (ESKD) secondary to NL/UL.

Methods

From the USRDS, we identified all patients with incident ESKD who initiated dialysis, 1995-2016. From the Medical Evidence Report (CMS-2728), we ascertained the kidney disease causing ESKD as reported by the patient's nephrologist. Categories included: NL/UL; diabetes; hypertension; glomerulonephritis, polycystic kidney disease (PKD); other urologic; and other/missing/unknown. We also noted patients' age, sex, race, Hispanic ethnicity, Medicaid coverage. Up to 11 comorbid conditions and health behaviors were also abstracted from form CMS-2728. Patients were followed from first dialysis to all-cause mortality, censoring at kidney transplant and end of database (12/2017). Cox proportional hazards regression models, stratified by year, estimated hazard ratios (HR) and corresponding 95% confidence intervals (CI).

Results

We studied 1,979,430 new ESKD patients, of whom 4190 (0.21%) patients had NL/UL as the reported cause of ESKD. Patients with NL/UL had similar age and sex distributions, but more were White (82 vs 66%) and fewer Black (11 vs 28%) or Hispanic (9 vs 13%) than among other causes of ESKD. All-cause mortality during median follow-up of 2.6 years was 173 per 1000 person-years among NL/UL patients. HR and 95% CIs comparing different causes of ESKD with NL/UL, at varying levels of model adjustment, are shown in Table.

Conclusion

Compared to patients whose ESKD was attributed to NL/UL, mortality was significantly higher among patients with DM, HTN, and other/unknown/missing cause of ESKD, but lower among patients with GN or PKD as cause of ESKD.

Mortality of Causes of ESKD vs. Nephro-/Urolithiasis [HR (95% CI)]
Nephro-/Urolithiasis (referent)Adjusted for Year of ESKD+Demographics and Medicaid+Comorbidities and Labs
Diabetes1.28 (1.23, 1.33)1.46 (1.40, 1.51)1.32 (1.27, 1.37)
Hypertension1.23 (1.18, 1.27)1.24 (1.19, 1.28)1.16 (1.11, 1.20)
Glomerulonephritis0.72 (0.70, 0.75)0.94 (0.90, 0.97)0.91 (0.88, 0.95)
Polycystic Kidney Disease0.56 (0.54, 0.58)0.68 (0.66, 0.71)0.70 (0.67, 0.73)
Other Urologic Cause1.12 (1.07, 1.16)1.06 (1.02, 1.10)1.02 (0.98, 1.07)
Other, Unknown, or Missing Cause1.31 (1.26, 1.36)1.38 (1.33, 1.43)1.28 (1.23, 1.33)

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