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Kidney Week

Abstract: PO0807

Associations of Pre-Dialysis Care with Trajectories of Adverse Clinical Outcomes Among Patients Initiating Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Weinhandl, Eric D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Kou, Chuanyu, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Guo, Haifeng, 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

Health care during advanced chronic kidney disease likely influences outcomes during the first year of end stage kidney disease (ESKD). We assessed associations of nephrology care, erythropoiesis-stimulating agent (ESA) therapy, and red blood cell (RBC) transfusion before hemodialysis initiation with trajectories of adverse clinical outcomes during the first year after initiation.

Methods

We analyzed United States Renal Data System data. The cohort included patients who initiated outpatient dialysis in 2014-2017 and carried Medicare coverage during the year preceding dialysis initiation. We stratified the cohort by care in that one-year interval: nephrology care (per ESRD Medical Evidence Report), ESA therapy (per Medicare claims), and RBC transfusion (per Medicare claims). In each stratum, we estimated weekly incidence of all-cause death, hospitalization, and three-point major adverse cardiac events (MACE) during the first 52 weeks of dialysis. We used joinpoint regression to estimate incidence trajectories.

Results

The cohort included 132,879 patients. Before dialysis initiation, 65% received nephrology care, 14% used an ESA, and 32% received an RBC transfusion. As shown, nephrology care and ESA therapy were associated with lower risks of adverse clinical outcomes during the first year of dialysis, whereas RBC transfusion was associated with higher risks. However, trajectories of weekly incidence during the first year were similar in all subgroups.

Conclusion

Pre-ESKD nephrology care and pre-ESKD ESA therapy were associated with lower risks of adverse clinical outcomes during the first year of dialysis, whereas RBC transfusion was associated with higher risks. Regardless of pre-ESKD care, risks were higher during the early part of the first year.

Funding

  • Commercial Support