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Abstract: TH-PO245

Relative Blood Volume Monitoring Using Crit-Line and Hospital Admissions: A Retrospective Analysis of over 25,000 Patients Across 330 Dialysis Clinics

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ficociello, Linda, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Zhou, Meijiao, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Han, Hao, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Hymes, Jeffrey L., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
Background

Relative blood volume (RBV) monitoring may help guide fluid management, but real-world data on its use and potential impact on hospital admissions in chronic hemodialysis is limited. We aimed to compare hospital admissions among Fresenius Kidney Care (FKC) clinics with high utilization of RBV and propensity score matched (PSM) clinics not using RBV.

Methods

All data was retrospective, de-identified, and collected as part of routine clinical care and spanned 7/1/22-12/31/2022. RBV was conducted using Crit-Line (CLiC; Crit-Line in a Clip) devices integrated into 2008T dialysis machines. 165 FKC clinics with high utilization of RBV (HI-RBV; >90% of HD treatments used RBV) were PSM to 165 clinics not using RBV (NO-RBV) based on the following: pt census, age, gender, race, primary insurance, diabetes, catheter use, and ESRD network. Hospital admission rates (all-cause and fluid-related), hospital days, and 30-day readmissions were calculated and compared as rate ratios (RR), rate differences (RD), and proportions along with 95% confidence intervals and p-values.

Results

Outcomes for HI-RBV clinic pts (n=11,845) compared to NO-RBV clinic pts (n=13,238) are shown in Table. We observed an 8% lower rate of hospital admissions (p<0.0001) and 14% lower rate of fluid-related hospital admissions (p=0.0002) comparing HI-RBV to NO-RBV. There were 13 and 4 fewer hospital admissions per 100 person years (py) for all-cause and fluid related, respectively, along with 113 fewer hospital days per 100 py comparing HI-RBV to NO-RBV (p<0.0001). We can estimate an additional 48 missed treatments per 100 py in NO-RBV clinics due to these excess hospital days. There was a trend toward lower 30-day readmissions among HI-RBV vs NO-RBV (25.5% vs 27.3%, p=0.049).

Conclusion

Clinics with high utilization of RBV experienced fewer all-cause (8%) and fluid-related (14%) hospital admissions and hospital days (113 days per 100 py) when compared to PSM clinics without RBV.

Funding

  • Commercial Support – Fresenius Medical Care