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Abstract: TH-PO771

Predialysis Care Pathways and Early Morbidity and Mortality After Transition to Dialysis in French Elderly

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Hamroun, Aghiles, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
  • Aymes, Estelle, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
  • Couchoud, Cécile, Agence de la biomedecine, La Plaine Saint-Denis, France
  • Dauchet, Luc, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
  • Gauthier, Victoria, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
  • Amouyel, Philippe, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
  • Glowacki, François, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
  • Stengel, Benedicte, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
Background

The ageing of the population with advanced chronic kidney disease (CKD) increases the complexity of care pathways. Our aim was to identify subgroups of elderly patients according to predialysis care pathways and describe their association with early death and hospitalization after transition to dialysis.

Methods

We included 22,128 incidents patients aged 75 or over (median age 82 years, 63% men) from the national ESKD REIN registry, 2010-2016, linked with the National Health Claim Data System. Predialysis care pathways were identified by multiple correspondence analyzes and ascending hierarchical classification, based on healthcare use. Their associations with death or hospitalization ≥ 50% of the time off dialysis within the first year of dialysis were studied by multivariate logistic regressions.

Results

Five care pathway profiles were identified characterized by nephrology ambulatory follow-up (37% of the patients), limited healthcare use (28%), non-nephrology ambulatory care (17%), and a high level of non-nephrology (9%) or nephrology hospitalizations (9%). Profile subgroups did not significantly differ according to demographic and clinical characteristics, and early mortality after dialysis initiation. Compared to the nephrology ambulatory follow-up profile, all other care pathway profiles were at higher risk of prolonged hospitalization after dialysis initiation (Figure 1, n = 1,195 patients).

Conclusion

Elderly patients with advanced CKD experienced very heterogeneous predialysis care pathways, which do not seem to be explained by their clinical profile. Improving nephrology outpatient follow-up may help reduce the burden of hospitalizations after the transition of dialysis in this population.

Predialysis care profile and risk of prolonged hospitalization