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Abstract: PO1371

Hospitalization Risk Among Advanced CKD Patients Treated with Conservative Management vs. Dialysis

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Rhee, Connie, University of California Irvine, Irvine, California, United States
  • You, Amy Seung, 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 VolShop Memphis, 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
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
Background

Regarded as the default treatment option for advanced CKD, dialysis has been associated with frequent hospitalizations, functional decline, and loss of independence, particularly in the elderly and comorbid. While there is rising interest in conservative management (CM) as an alternative treatment option, this strategy remains underutilized. We sought to quantify differences in healthcare utilization in advanced CKD patients transitioning to dialysis vs. CM.

Methods

We compared hospitalization risk in 309,188 advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) treated with dialysis vs. CM 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. We examined hospitalizations within 2-yrs of the index eGFR (1st eGFR <25), which were parsed into pre- and post-dialysis transition hospitalizations in those treated with dialysis. We also examined the composite endpoint of hospitalization+death within 2-yrs of the index eGFR to account for death as competing event for hospitalization.

Results

In the overall cohort, 55% and 20% of patients experienced ≥1 hospitalization(s) and death, respectively, within 2-yrs of the index eGFR. Patients who transitioned to dialysis were more likely to be hospitalized vs. those treated with CM (77% and 47%), with a larger proportion of hospitalizations occurring pre- vs. post-dialysis transition in the former group (57% vs. 20%). While the proportion of deaths across dialysis vs. CM were similar (18% vs. 20%), the composite endpoint was more frequent in patients treated with dialysis vs. CM (79% and 55%).

Conclusion

In a national cohort of advanced CKD patients, while the proportion of death events was similar in those treated with dialysis vs. CM, patients who transitioned to dialysis had higher hospitalization risk. Further studies are needed to compare the components and effectiveness of CM vs. dialysis on CKD outcomes.

Funding

  • NIDDK Support