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Abstract: PO1255

Home-Based Dialysis Care Among Veterans Within the Veterans Affairs Health Care System, 1995-2014

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Reule, Scott, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Ishani, Areef, Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
  • Sexton, Donal J., University of Dublin Trinity College, Dublin, Ireland
  • Foley, Robert N., United States Renal Data System, Minneapolis, Minnesota, United States
Background

Contemporary US policy is focused on proportionally increasing home-based dialysis care, however overall rates are lower in the US compared to other similarly developed countries. Use of peritoneal dialysis (PD), the most common home-based dialysis modality, is even lower among US Veterans. How the characteristics and rates of PD utilization among US Veterans vary by health system affiliation, is unknown.

Methods

Using United States Renal Data Systems (USRDS) combined with Medicare data for the years 1995-2014, we matched US Veterans initiating dialysis (n =14,904) to Veterans and Medicare non-Veterans receiving care in the community. Matching was performed in a 1:1 ratio according to year of dialysis initiation (+/- 2 years), age (+/- 2 years), gender, race, and reported cause of kidney disease. A total of 668 veterans initiated PD within the VA, compared to 890 Veterans and 1,436 non-Veterans in the community.

Results

After adjustment for patient age, gender, race, ethnicity, and region of residence, odds (AOR) of PD initiation within the VA was highest among those with diabetes mellitus (AOR 1.36; CI 1.18-1.57), tobacco use (AOR 1.59; CI 1.25-2.02), and a history of cancer (AOR 1.49; CI 1.10-2.02) and lowest for those of Hispanic ethnicity (AOR 0.73; CI 0.56-0.95), history of heart failure (AOR 0.74; CI 0.62-0.88). In 1995-1996, patients receiving Medicare coverage within the community were most likely to utilize PD compared to Veterans within the community and within the VA (18.9% vs. 9.6% and 8.2%, respectively), an observation that remained consistent over time. PD utilization among African-American Veterans was lower overall, although more closely approached estimates in white Veterans in more recent years.Veteran survival vs. Medicare controls is shown in Figure 1.

Conclusion

While PD utilization among Veterans is lower within the VA, the observed mortality benefit for care receipt within the VA was reassuring.