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Abstract: FR-OR22

Real-World Analysis of Timing of Dialysis Transition and Mortality in a Nationally Representative Cohort of Advanced CKD Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

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

While there is substantial variation in the timing of the dialysis initiation in advanced CKD patients transitioning to ESRD, large population-based studies have observed a trend towards earlier dialysis transition over time. We sought to conduct a real-world analysis of the impact of timing of dialysis transition on mortality rates in a nationally representative cohort of advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days).

Methods

In advanced CKD patients transitioning to dialysis over 1/1/07-6/30/20, we examined the impact of timing of dialysis transition (defined by eGFR at the time of dialysis initiation) on mortality rates. Patients were identified 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 granularly categorized according to novel time-intervals of dialysis transition, defined as CKD stages 4B, 4C, 5A, 5B, and 5C (eGFRs 20-<25, 15-<20, 10-<15, 5-<10, and <5 at the time of dialysis transition, respectively). Poisson regression was used to compare mortality rates across exposure groups.

Results

Among 97,320 advanced CKD patients who transitioned to dialysis, 6%, 11%, 31%, 43%, and 9% initiated treatment at CKD stages 4B, 4C, 5A, 5B, and 5C. Patients who underwent incrementally earlier dialysis transitions experienced increasingly higher raw mortality rates: 118, 128, 141, 155, and 164 deaths per 1000 person-yrs for CKD stages 5C, 5B, 4C, and 4B. A similar trend was observed for Poisson model-based mortality rates in the overall cohort, as well as raw and model-based mortality rates stratified by age (<65 vs. ≥65 yrs).

Conclusion

In a real-world analysis of a nationally representative US cohort, incrementally earlier dialysis transitions demonstrated increasingly higher mortality rates. Further studies are needed to identify strategies optimizing survival in advanced CKD patients transitioning to dialysis.

Funding

  • NIDDK Support