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Abstract: PO1021

The Association of Transition-to-Dialysis Planning and Healthcare Resource Use and Mortality in Patients with ESRD

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Poonawalla, Insiya B., Humana Healthcare Research, Inc., Louisville, Kentucky, United States
  • Barve, Kanchan, Humana Inc, Louisville, Kentucky, United States
  • Cockrell, Meghan Martin, Humana Inc, Louisville, Kentucky, United States
  • Agarwal, Amal, Humana Inc, Louisville, Kentucky, United States
  • Casebeer, Adrianne W., Humana Inc, Louisville, Kentucky, United States
  • Li, Yong, Humana Healthcare Research, Inc., Louisville, Kentucky, United States
Background

The onset of ESRD is associated with poor outcomes and high mortality, and the role of transition-to-dialysis planning is not well understood. We evaluated the association between dialysis transition planning factors such as nephrologist care, vascular access placement, and place of index dialysis, with inpatient (IP) stays, emergency department (ED) visits, and mortality.

Methods

This retrospective study used the Humana Research Database to identify 7,026 patients, 19-89 years of age, diagnosed with ESRD between 1/1/17 and 12/31/17, enrolled in a Medicare Advantage Prescription Drug plan, with >12 months of continuous enrollment pre- and post-index date (i.e., first evidence of ESRD). Patients with a kidney transplant indication, hospice election, or dialysis pre-index were excluded. Transition-to-dialysis planning was defined as optimal, partial, or unplanned (Table 1). IP stays, ED visits, and mortality were evaluated within 12 months post-index.

Results

The cohort was 41% female, 66% White, with an average age of 70 years. An optimally planned, partially planned, and unplanned transition to dialysis occurred for 15%, 34%, and 44% of the ESRD cohort, respectively. Among patients with pre-index CKD stages 3a and 3b, 64%, and 55%, respectively, had an unplanned dialysis transition. For patients with pre-index CKD stages 4 and 5, 68% and 84%, respectively, experienced planning prior to dialysis initiation. In adjusted models, patients with partially or optimally planned transition to dialysis were 57% to 72% less likely to die, 20% to 37% less likely to experience an IP stay, and 80% to 100% more likely to experience an ED visit than patients with an unplanned transition. Higher ED utilization with planned transition was attributed to longer time to mortality, allowing more time for healthcare utilization.

Conclusion

A planned transition to dialysis was associated with improved outcomes and lower mortality. Targeting care coordination for patients with CKD stages 3a/3b may help slow disease progression and ensure a planned, safer transition to dialysis.

Table 1. Transition-to-Dialysis Planning Definitions
Optimal: Vascular access placed
Partial: Nephrologist care but no vascular access
Unplanned: Dialysis in IP stay or ED visit