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Kidney Week

Abstract: PO0795

Weekly Risks of Death and Hospitalization Among Incident Patients Undergoing Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Weinhandl, Eric D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Guo, Haifeng, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Kou, Chuanyu, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Davis, Jill, AstraZeneca PLC, Wilmington, Delaware, United States
  • Cremisi, Henry D., AstraZeneca PLC, Wilmington, Delaware, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

During the first year of hemodialysis, risks of mortality and morbidity are elevated. However, it remains unclear when patients transition from relatively higher "incident" risk to relatively lower "prevalent" risk. We estimated trajectories of weekly risks of death and hospitalization among patients who recently initiated hemodialysis.

Methods

We analyzed data from the United States Renal Data System. The cohort included all patients who initiated outpatient hemodialysis in 2014-2017; for analysis of hospitalization, we limited the cohort to patients with Medicare Parts A and B coverage. We estimated the weekly incidence of each of death and hospitalization during the first 52 weeks of hemodialysis. We used joinpoint regression with a maximum of five knots to estimate best linear interpolations of incidence trajectories.

Results

The cohort included 395,233 incident patients. Risk of death peaked in dialysis week 4. As displayed with joinpoint regression, there were four phases of risk: high and sharply increasing risk from week 1 to 3; high but steadily decreasing risk from week 3 to 13; moderate and gradually decreasing risk from week 13 to 30; and consistent risk from week 30 to 52. Risk of hospitalization was highest in dialysis week 1. There were four phases of risk: high but sharply decreasing risk from week 1 to 5; moderate and steadily decreasing risk from week 5 to 11; moderate and gradually decreasing risk from week 11 to 24; and consistent risk from week 24 to 52.

Conclusion

Weekly risks of death and hospitalization are highest during the first 13 to 14 weeks after initiation of outpatient hemodialysis, and gradually decline thereafter. However, risk trajectory details—including the timing of the transition from “incident” to “prevalent” status—vary among outcomes.

Funding

  • Commercial Support