Abstract: SA-PO312
A Comparison of Mortality Between Unplanned and Planned Hemodialysis Initiation in Incident ESKD Patients: A Long-Term Observational Study
Session Information
- Hemodialysis and Frequent Dialysis: Potpourri
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Okamoto, Keisuke, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan
- Eriguchi, Masahiro, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan
- Samejima, Ken-ichi, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan
- Tsuruya, Kazuhiko, Nara Kenritsu Ika Daigaku, Kashihara, Nara, Japan
Background
Planned hemodialysis (HD) initiation with a matured vascular access is recommended in terms of patients’ survival compared to unplanned HD initiation with a temporary vascular catheter in several guidelines across the world. This is based on several short-term observational studies, whereas long-term outcomes have been rarely evaluated.
Methods
We consecutively assessed newly declared ESKD patients who started HD between 1/1/2007 and 12/31/2014 at Nara Medical University Hospital. We excluded patients who had dialysis-dependent acute kidney injury (AKI) leading to ESKD, recovered from AKI, underwent continuous kidney replacement therapy as the only dialysis modality, or had HD for extra-renal indication. We stratified patients into 2 groups (unplanned vs planned HD initiation) and compared survival using the Kaplan-Meier method with or without a propensity score matching. The primary outcome was all-cause mortality during the observational period until 12/31/2020.
Results
Of the 460 newly declared ESKD patients who were assessed for eligibility, 345 patients (172 unplanned and 173 planned HD initiation) were included in this study. The median follow-up duration of the entire cohort was 4.59 years (range, 1.45-7.84 years). Figure 1 showed Kaplan-Meier survival curves which presented no statistically significant difference in crude survival between unplanned and planned HD initiation (Figure 1A, Log-rank P = 0.235), however, revealed a statistically significant difference in survival in the propensity score-matched cohort (Figure 1B, Log-rank P = 0.046). The hazard ratio for mortality in the unplanned HD initiation group was 1.515 [95% confidence interval 1.005-2.282] in the propensity score-matched cohort.
Conclusion
In this cohort of newly declared ESKD patients who started HD, those who were in the planned HD initiation group had better long-term survival in the propensity score-matched cohort. This finding supports the usefulness of creating permanent vascular access before starting HD for not only short-term but also long-term survival.
Figure 1