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Abstract: SA-PO378

A Retrospective Analysis of Fluid and Infection-Related Hospitalizations in Clinics Participating in ESRD Seamless Care Organizations

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Lasky, Rachel A., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Ficociello, Linda, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Ketchersid, Terry L., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Hippen, Benjamin E., Fresenius Medical Care, Waltham, Massachusetts, United States

In a pilot program aimed at controlling costs and improving care for patients (pts) with end-stage renal disease (ESRD), the Center for Medicare and Medicaid Innovation (CMMI) created ESRD Seamless Care Organizations (ESCOs) in 2015. We conducted a retrospective data analysis to evaluate potentially preventable hospitalizations, namely fluid-related and infection-related, in ESCO-eligible pts who received dialysis at ESCO vs non-ESCO clinics.


Adult, Fresenius Kidney Care (FKC) hemodialysis pts who met ESCO eligibility criteria between 10/2015-3/2017 were included. ESCO pts received dialysis at 1 of 6 FKC ESCO markets, while non-ESCO pts were dialyzed at nearby FKC facilities propensity score matched on: # ESCO eligible pts, mean dialysis vintage, mean pt age, %pts with diabetes, %pts with dual-eligibility, median income by zip code, and geographical proximity. Fluid and infection-related hospitalizations were identified using ICD codes from electronic medical records. Crude and adjusted Poisson regression models were used to compare the risk of fluid- and infection-related hospitalizations between ESCO and non-ESCO groups, overall and stratified by the presence of catheters (CVC).


13,994 pts (7,398 ESCO and 6,596 non-ESCO) were included. Compared to pts attending non-ESCO clinics, pts attending ESCO clinics had 0.88 (p=0.0001) and 0.85 (p < 0.0001) times the rate of infection-related and fluid-related hospitalizations, respectively (table). With multivariate adjustment, only fluid-related hospitalizations remained statistically significant (RR:0.84, p=0.0002). The stratified analysis demonstrates that the pts with most reduced risk of infection and fluid-related hospitalizations are the pts being dialyzed with CVC (table).


Pts that received hemodialysis in FKC ESCO clinics experienced a lower rate of fluid-related hospitalizations when compared to pts in non-ESCO clinics, a benefit primarily realized by patients dialyzing with a CVC.


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