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Abstract: PO2327

Impact of Race/Ethnicity and Age on Survival in Advanced CKD Patients Treated with Conservative Management vs. Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

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

Given evidence that dialysis may not offer survival benefit nor improved quality of life in certain groups (elderly, multi-morbid), there is growing interest in conservative management (CM) as an alternative treatment strategy for advanced CKD. Yet little is known about the impact of CM vs. dialysis on CKD outcomes, including mortality, across different racial/ethnic and age groups.

Methods

In a national cohort of 309,188 advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days), we compared mortality rates in patients 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 according to timing of dialysis initiation, defined as late, intermediate, vs. early dialysis (eGFRs <5, 5-<10, vs. ≥10 at dialysis transition). We used Poisson regression to compare mortality rates in CM vs. dialysis patients across race/ethnicity and age.

Results

Whereas late, intermediate, and early dialysis had higher mortality rates than CM in Non-Hispanic Whites across all age groups, in Hispanic patients CM and dialysis had similar mortality rates across all ages. In Non-Hispanic Blacks, Asians, and Other races/ethnicities, CM vs. late dialysis had similar mortality rates among those ≥75 yrs old, whereas CM demonstrated survival benefit vs. all dialysis groups in younger ages.

Conclusion

In a diverse, nationally representative cohort of CKD patients, we observed differential relationships between CM vs. dialysis on mortality rates across race/ethnicity and age. Further research is needed to determine which patient characteristics and health services optimize candidacy and choice of CM vs. dialysis to enable a personalized approach.

Funding

  • NIDDK Support