Kidney Week

Abstract: SA-PO304

Medication Utilization Among US Veterans With Advanced CKD Receiving Conservative Management vs. Dialysis

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

• Narasaki, Yoko, University of California Irvine, Irvine, California, United States

Yoko Narasaki,

• Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States

Kamyar Kalantar-Zadeh,

• Crowley, Susan T., Yale University, New Haven, Connecticut, United States

Susan T. Crowley,

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Mukamel, Dana B., University of California Irvine, Irvine, California, United States

Dana B. Mukamel,

• You, Amy Seung, University of California Irvine, Irvine, California, United States

Amy Seung You,

• Yoon, Ji Hoon, University of California Irvine, Irvine, California, United States

Ji Hoon Yoon,

• Nguyen, Danh V., University of California Irvine, Irvine, California, United States

Danh V. Nguyen,

• Rhee, Connie, University of California Irvine, Irvine, California, United States

Connie Rhee,

Background

Within the Veterans Health Administration, the largest integrated healthcare system in the US, 1.1 million Veterans (16%) have CKD among whom ~10% annually progress to ESKD requiring dialysis or transplant. While dialysis has been the prevailing paradigm in this population, there has been growing interest in non-dialytic conservative management (CM) as an alternative patient-centered treatment strategy for advanced CKD. We sought to examine medication utilization patterns among Veterans with advanced CKD treated with CM vs. dialysis.

Methods

In a national cohort of US Veterans, we examined patients with advanced CKD (≥2 eGFRs <25ml/min/1.73m² separated by ≥90 days) from 10/2010-9/2019. Using linked USRDS and Medicare (CMS) data, we compared medication utilization within 1-year prior to the index eGFR (1^st eGFR <25ml/min/1.73m²) among patients categorized according to 1) receipt of CM, defined as those who did not receive dialysis within 2-years of the index eGFR, vs. 2) receipt of dialysis within 2-years of the index eGFR.

Results

Among 106,089 advanced CKD patients who met eligibility criteria, 25% (N=26,113) and 75% (N=79,956) were treated with dialysis vs. CM, respectively. Compared to the CM group, the dialysis group had higher utilization of anticoagulation/antiplatelet, anemia, analgesic, psychiatric, diuretic, anti-diabetes, and calcium/vitamin D agents (Fig); however, there was a similar prevalence of anti-HTN, phosphate binder, and GI medications.

Conclusion

Among US Veterans with advanced CKD, there tended to be higher utilization of most medication classes in the dialysis group as compared with CM patients. Further studies are needed to define the optimal pharmacotherapeutic management strategies among advanced CKD patients treated with CM vs. dialysis.

Funding

• NIDDK Support