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Abstract: PO1372

Mortality Rates in a Nationally Representative Cohort of Advanced CKD Patients Treated with Conservative Management vs. Dialysis

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • You, Amy Seung, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Mukamel, Dana B., University of California Irvine, Irvine, California, United States
  • Crowley, Susan T., Yale University School of Medicine, New Haven, Connecticut, United States
  • Novoa-Vargas, Alejandra, University of California Irvine, Irvine, California, United States
  • Nguyen, Danh V., University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
Background

While dialysis has been the prevailing treatment paradigm in CKD patients progressing to ESRD, this treatment approach may not offer survival benefit nor improved quality of life in certain subgroups (elderly, multi-morbid). Hence, there is growing interest in conservative management (CM) as an alternative treatment strategy in advanced CKD.

Methods

We compared mortality rates in advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) treated with CM vs. dialysis from 1/1/07-6/30/20 from the OptumLabs® Data Warehouse (OLDW), which contains de-identified administrative claims, including medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees as well as electronic health record data. Patients were categorized according to receipt of dialysis vs. CM, defined as those who did vs. did not receive dialysis within 2-yrs of the index eGFR (1st eGFR <25), with the former group parsed into late vs. early dialysis (eGFRs <15 vs. ≥15 at dialysis transition). Secondary analyses stratified the former group as late, intermediate, vs. early dialysis (eGFRs <5, 5-<10, vs. ≥10 at dialysis transition). Poisson regression was used to compare mortality rates across exposure groups.

Results

Among 309,188 advanced CKD patients, 60% vs. 40% of patients were treated with CM vs. dialysis, respectively. Patients who underwent CM vs. late dialysis had similar mortality, whereas those who underwent early dialysis had the highest mortality rates. In secondary analyses comparing CM and late vs. intermediate vs. early dialysis, a similar pattern was observed (140, 126, 141, vs. 158 deaths per 1000 person-yrs, respectively). In age-stratified analyses, compared to CM, all dialysis groups had higher mortality rates irrespective of timing of initiation in those <65 and ≥65 yrs old.

Conclusion

In a nationally representative cohort of advanced CKD patients, CM vs. late dialysis demonstrated similar mortality, whereas those who underwent early dialysis had the highest mortality rates.

Funding

  • NIDDK Support