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Abstract: PO0103

A Novel Approach to Identify Nonclinical Factors That Impact Outcomes in Dialysis Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Ryan, Claire, DaVita Inc, Denver, Colorado, United States
  • Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Engel, Janice, DaVita Inc, Denver, Colorado, United States
  • Pace, Amber, DaVita Inc, Denver, Colorado, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Filus, Ania, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
Background

Nonclinical factors heavily impact quality of life and outcomes in severely ill patients. In oncology, self-reported levels of distress are routinely assessed to identify patients with higher risk of adverse outcomes and possible interventions. While similar dynamics may be at play in dialysis, this type of screening is not part of the current standard of care. In order to potentially enhance a patient-centered and holistic approach to care, we tested the use of the distress thermometer (DT) among patients dialyzing at a large dialysis organization.

Methods

Between September 2019 and January 2021, social workers administered a dialysis-adapted version of the DT. Associations between DT scores and outcomes were assessed in logistic regression models adjusted for age, race, sex, and dialysis vintage. Models in in-center hemodialysis (ICHD) patients were also adjusted for vascular access type. Additionally, outcomes were compared between patients who selected specific items off the problems lists and those who did not select that specific problem.

Results

This analysis included data from 32,174 patients (N = 25,447 ICHD and N = 6727 peritoneal dialysis [PD]). The refusal rate was 11.4% and 4.7% among ICHD and PD patients, respectively (10.0% overall). The mean ± SD DT score was 3.22 ± 2.85 for all patients, 3.29 ± 2.87 for ICHD patients, and 2.96 ± 2.75 for PD patients. High DT scores (≥7) were associated with hospitalization among both ICHD (odds ratio [95% CI] = 1.22 [1.07-1.39]) and PD (1.51 [1.11-2.05]) patients and with greater risk of PD discontinuation (1.77 [1.38-2.25]). Problems attributed to transportation and housing were associated with greater risk of missing an in-center treatment (1.36 [1.23-1.50] and 1.37 [1.23-1.52], respectively). Physical problems were associated with increased risk for hospitalization among ICHD patients (1.08 [1.06-1.10]) and PD patients (1.07 [1.02-1.11]), and missed treatments among ICHD patients (1.03 [1.01-1.04]).

Conclusion

We found that a novel screening tool may be useful in identifying dialysis patients at high risk for adverse clinical outcomes. Moreover, specific responses on this tool may help identify specific problems that are driving this risk. Practices aimed at addressing such problems could have the potential to impact quality of life and clinical outcomes.