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Kidney Week

Abstract: PO1373

Continued Primary Care Use During the Transition to Kidney Failure with Renal Replacement Therapy (KFRT) Is Associated with Reduced Mortality Among Older Hemodialysis (HD) Patients

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Greer, Raquel C., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Ahn, JiYoon B., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Plantinga, Laura, Emory University, Atlanta, Georgia, United States
  • Sperati, John, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • McAdams-DeMarco, Mara, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Beers, Kelly H., Albany Medical College, Albany, New York, United States
  • Soman, Sandeep S., Henry Ford Hospital, Detroit, Michigan, United States
  • Choi, Michael J., MedStar Georgetown University Hospital, Washington, District of Columbia, United States
  • Jaar, Bernard G., Johns Hopkins Medicine, Baltimore, Maryland, United States

Group or Team Name

  • National Kidney Foundation Education Committee
Background

Primary care providers (PCPs) are responsible for addressing patients’ comprehensive health needs. However, the provision of primary care during the KFRT transition and its contribution to clinical outcomes among in-center HD patients have not been well explored.

Methods

We quantified the associations between PCP use, mortality, and hospitalization among older (age≥67) incident (2008-2014) in-center HD patients using data from the United States Renal Data System. We defined patients’ PCP use 1-year prior and 1-year post-KFRT as “continued” for PCP use pre- and post-KFRT; “initiated” for no PCP use pre-KFRT and PCP use post-KFRT; “discontinued” for PCP use pre-KFRT and no PCP post-KFRT; or “never used” as no PCP use pre- or post KFRT. We used Cox proportional hazard models and adjusted for confounding by using inverse probability weighting method to estimate hazard ratios (HRs) for all-cause mortality and first all-cause hospitalization up to 2 years post-KFRT.

Results

Among 111,424 patients, 57% had continuity of PCP care, 10% initiated PCP use, 10% discontinued PCP use, and 23% never used PCP care during the KFRT transition. Compared to those who never used primary care during the KFRT transition, those with continued primary care use had a 14% lower risk of mortality. Continued and initiated PCP care post-KFRT transition was associated with a 5-12% higher risk of hospitalization, respectively.

Conclusion

Continued primary care use during the KFRT transition was associated with lower mortality, but a higher risk of hospitalization. Additional studies are needed to determine the aspects of primary care that may be beneficial and which patients are most likely to benefit from continued PCP use.

Hazard Ratios for All-Cause Mortality and First Hospitalization by Primary Use during KFRT Transition
 Never usedDiscontinuedInitiatedContinued
 HR (95% CI)*HR (95% CI)*HR (95% CI)*HR (95% CI)*
All-cause MortalityRef1.01 (0.96-1.05)0.97 (0.93-1.02)0.86 (0.83-0.89)
First all-cause hospitalizationRef1.00 (0.98-1.02)1.12 (1.10-1.15)1.05 (1.03-1.06)

*Adjusted for age, sex, race/ethnicity, employment, Medicaid, region, %neighborhood-level poverty, %neighborhood urban, Kim’s frailty index, Liu’s comorbidity index, pre-KFRT nephrology care

Funding

  • Private Foundation Support