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Abstract: SA-PO936

Charlson Comorbidity Index as a Predictor of Mortality in ESRD Inpatients in Rural America: Evidence From a Nationally Representative Sample

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Author

  • Adeyemi, Emmanuel Olusola, Saint Peter's University Hospital, New Brunswick, New Jersey, United States
Background

End Stage Renal Disease (ESRD) has been associated with an increase in all-cause mortality among patients. The accumulation of comorbidities appears to be a contributing factor. This study set out to identify the effect of comorbidity severity among ESRD inpatients in rural America.

Methods

This is a cross-sectional study that used the 2016-2018 Nationwide Inpatient Survey (NIS) from the Healthcare Cost and Utilization Project (HCUP). The study included patients aged 18yrs or more with ESRD hospitalized in rural hospitals in America. Independent variables used from the survey include age, gender, race, type of admission (elective vs non-elective), type of hospital control, expected primary payer, and severity of comorbidities. The dependent variable was death during hospitalization. All analyses were weighted. Univariate (frequencies), bivariate (Chi-square) and logistic regression (stepwise selection with P-value for entry of a variable and stay of a variable put at <=0.05) analyses were done using SAS studio.

Results

There were 144,575 weighted ESRD hospitalizations. 5.0% of hospitalizations died. Gender was the only non-significant variable on bivariate analysis (P=0.6577), hence, gender was not considered in our regression model. On multivariable logistic regression analysis that adjusted for age, race, type of admission, type of hospital control, and expected primary payer; ESRD patients with severe comorbidities had 40% (AOR: 1.40, 95% CI: 1.26-1.54) more odds of mortality compared to those with mild comorbidities and those with moderate comorbidities had 22% (AOR:1.22 95% CI: 1.10-1.36) more odds of mortality compared to those with mild comorbidities. The area under the curve (AUC) for the model was 62%.

Conclusion

Severity of comorbidities is a modifiable predictor of ESRD inpatient mortality from this study. This suggests that strategies aimed at preventing accumulation of comorbidities might help reduce ESRD inpatient mortality in rural America.