Abstract: SA-PO337
Comparative Effect of Pre-Dialysis Nephrologic Care on Long-Term Mortality and Hospitalization After Dialysis Initiation
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
- Haarhaus, Mathias, Diaverum, Malmö, Sweden
- Bratescu, Lavinia Oltita, Diaverum Romania, Bucharest, Romania
- Pana, Nicolae, Diaverum Romania, Bucharest, Romania
- Gemene, Emanuela Marta, Diaverum Romania, Bucharest, Romania
- Stojceva, Olivera, Diaverum North Macedonia, Skopje, Macedonia (the former Yugoslav Republic of)
- Silva, Eliana Mendonça Almeida, Diaverum, Malmö, Sweden
- Santos Araujo, Carla Alexandra R., Diaverum, Malmö, Sweden
- Macario, Fernando, Diaverum, Malmö, Sweden
Background
A structured pre-dialysis nephrological care model may impact on patient outcome after dialysis initiation. We aimed to determine the effect of a structured nephrological care program on mortality and hospitalizations during the first 5 years after dialysis initiation.
Methods
Between January 2015 and July 2018, 349 patients with end-stage renal disease who started dialysis in 9 Romanian dialysis clinics were included. In a retrospective analysis, patients followed by a nephrologist prior to dialysis initiation (N=124) were compared to patients followed in primary care (N=225). The obseravational period ended December 2020 or at death or loss to follow-up. anonymized clinical and laboratory data were retrieved from the dialysis provider’s quality database. Patients followed for at least 1 month after dialysis initiation were included in the data analyses. Missing data were imputed using multiple imputations.
Results
Patients were followed for a median (25-75%) of 42 (26-50) months. Baseline age was 64 (54-70) years, there were 42.2% females and 34.9% diabetics with no significant differences between groups. At dialysis start, patients followed by a nephrologist had higher hemoglobin (9.9 (9.1-10.6) g/dl, vs. 8.4 (7.8-9.4)g/L, p <0.001) and higher albumin (3.5 (3.2-4.1) g/dL, p<0.001) than patients followed in primary care, whereas Charlson Comorbidity Index was comparable between groups (6 (4-7) vs. 6 (4-7), p=0.9). Logistic regression analysis, correcting for age, gender, hemoglobin, albumin, mean arterial pressure (MAP), and Charlson Comorbidity Score, demonstrated a lower risk for an annual hospitalization rate >1 for patients followed by a nephrologist (Exp(B) 0.30 (confidence interval 0.13-0.67), p=0.005). A Cox regression model, correcting for the same covariables, revealed a lower mortality risk in patients followed by a nephrologist (Exp(B) 0.45 (CI 0.27-0.74), p=0.002).
Conclusion
Our structured pre-dialysis care model was associated with improve survival and lower hospitalization rate during a median follow-up period of more than 3 years after dialysis initiation, compared to patients followed in primary care. These results may impact on the design of pre-dialysis care models for patients with advanced CKD.
Note: This presentation will include updated results.
Funding
- Commercial Support –