Abstract: FR-PO942
Lower Central Venous Catheter Rates With Use of Kidney Failure Risk Reporting
Session Information
- CKD: Epidemiology, Risk Factors, Prevention - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention
Authors
- Willetts, Joanna, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Strubler, Diana, Acumen Physician Solutions, Nashville, Tennessee, United States
- Jiao, Yue, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Chaudhuri, Sheetal, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Larkin, John W., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Usvyat, Len A., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Gopal, Sam, Acumen Physician Solutions, Nashville, Tennessee, United States
- McNamara, Timothy, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care AG & Co KGaA, Bad Homburg, Hessen, Germany
Background
About 80% of kidney failure patients initiate hemodialysis (HD) with a central venous catheter (CVC), a rate that has been unchanged for decades (USRDS 2021). There is an unmet need to reduce CVC use at the transition to HD, which may be secondary to the dynamic nature of chronic kidney disease (CKD) progression and barriers in patient education/literacy. Since 2018, an electronic health record (EHR) system for CKD practices made a glomerular filtration rate (GFR) forecast reporting tool available to nephrologists. This report is based on a machine learning model that predicts the bi-monthly change in GFR over the next year. To understand the potential impacts of this risk reporting, we assessed its use by nephrologists and the CVC rates among patients who progressed to kidney failure and started HD.
Methods
We used data from an EHR system for CKD practices in the United States. We included data from nephrologists with ≥15 patients who progressed from CKD to kidney failure and initiated HD from April 2018-2020. We categorized nephrologists by use of the GFR forecast tool. Frequent users accessed the tool for >5% of their CKD patients, occasional users accessed the tool for 0-1% of their CKD patients, and non-users never accessed the tool, then we assessed CVC rates at HD initiation.
Results
Among 677 nephrologists, 34 were frequent users, 177 were occasional users, and 466 never used the GFR forecaster. Nephrologists provided care to 459,586 CKD patients, of which 26,164 progressed to kidney failure and started HD. Patients treated by nephrologists who were frequent users of the risk report had a 4.9 and 4.2 percentage point lower CVC rate at the start of HD compared to occasional and non-users of the tool, respectively (Figure 1).
Conclusion
We found frequent use of a kidney failure risk report associates with lower CVC rates at HD initiation. CVCs continue to be the primary access type used at the start of HD. Adoption of kidney failure risk reporting may provide some help through decision support and a way to enhance patient education in care planning.
Funding
- Commercial Support –