Kidney Week

Abstract: SA-PO707

Clinic-Level Fluid Quality Score Associates with Fluid Overload Hospitalizations

Session Information

• Fluid, Electrolyte, Acid-Base Disorders: Clinical - II
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Scoggins, Tory, Fresenius Medical Care, Waltham, Massachusetts, United States

Tory Scoggins,

• Mccarley, Patricia, Fresenius Medical Care, Waltham, Massachusetts, United States

Patricia Mccarley,

• Rivenbark, Amanda Short, Fresenius Medical Care, Waltham, Massachusetts, United States

Amanda Short Rivenbark,

• Stennett, Amanda, Fresenius Medical Care, Waltham, Massachusetts, United States

Amanda Stennett,

• Ash, Brian Scott, Fresenius Medical Care, Waltham, Massachusetts, United States

Brian Scott Ash,

• Yatsuhashi, Kathleen, Fresenius Medical Care, Waltham, Massachusetts, United States

Kathleen Yatsuhashi,

• Becker, Kellie Y., Fresenius Medical Care, Waltham, Massachusetts, United States

Kellie Y. Becker,

• Monaghan, Caitlin, Fresenius Medical Care, Waltham, Massachusetts, United States

Caitlin Monaghan,

• Chaudhuri, Sheetal, Fresenius Medical Care, Waltham, Massachusetts, United States

Sheetal Chaudhuri,

• Larkin, John W., Fresenius Medical Care, Waltham, Massachusetts, United States

John W. Larkin,

• Hymes, Jeffrey L., Fresenius Medical Care, Waltham, Massachusetts, United States

Jeffrey L. Hymes,

Background

Fluid overload (FO) is a primary cause of hospitalization in the dialysis population. A national dialysis network established a Fluid Action Group (AG) system to help identify patients on hemodialysis (HD) with clinical presentations associated with hypervolemia to prompt timely evaluations/interventions. Fluid AG assignments for patients are used to calculate a Fluid Clinical Quality Score (CQS) for each HD clinic. This analysis investigated if Fluid CQS was meaningfully associated with FO hospitalizations.

Methods

Fluid AG scoring assigns patients into groups representing a low-to-high FO risk based on the presence of post-HD hypertension coupled with excess interdialytic fluid gains, missed/shortened treatments, unchanged/increased estimated dry weights, and/or multiple blood pressure medications. Fluid CQS Score was calculated based on percent of patients in AGs with the median scoring 5, top decile scoring 10, and bottom decile scoring 1.
Data on the Fluid CQS and the average rolling 12-month hospitalization rate considering exposure time were collected from 9/2022- 2/2023. FO hospitalization rate was averaged for each level of the Fluid CQS.

Results

Among patients treated at 2,705 clinics, we observed an inverse relationship between higher Fluid CQS scores and lower FO hospitalization rates (R² = 0.93). Average FO hospitalization rate was 25% lower at clinics with a Fluid CQS score of 10 vs 1 (0.16 vs 0.12 FO admissions/patient year at clinics with a Fluid CQS score of 10 vs 1, respectively). Consistent trends were observed during each month individually.

Conclusion

Fluid CQS appears to be meaningfully correlated with FO outcomes observed at a clinic and can be viewed as a surrogate marker of the management of fluid control. Further investigations are needed to understand the effectiveness of interventions being performed based on Fluid AG for individual patients.

Funding

• Commercial Support – Fresenius Medical Care