Abstract: SA-PO535
Dialysis Transition in Patients with and Without Heart Failure in a CKD Population
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Bhandari, Simran K., Kaiser Permanente Southern California, Los Angeles, California, United States
- Pak, Katherine J., Kaiser Permanente Southern California, Los Angeles, California, United States
- Zhou, Hui, Kaiser Permanente Southern California, Los Angeles, California, United States
- Shaw, Sally F., Kaiser Permanente Southern California, Los Angeles, California, United States
- Shi, Jiaxiao, Kaiser Permanente Southern California, Los Angeles, California, United States
- Broder, Benjamin, Kaiser Permanente Southern California, Los Angeles, California, United States
- Sim, John J., Kaiser Permanente Southern California, Los Angeles, California, United States
Background
CKD and heart failure (HF) frequently coexist and are associated with worsened outcomes. We sought to compare CKD patients with and without HF who transitioned to dialysis.
Methods
Retrospective study between Jan 2007 and Dec 2018 among incident CKD adult patients who initiated dialysis within Kaiser Permanente. Incident CKD identified as≥2 consecutive eGFR≤45 at least 90 days apart with one prior eGFR≥60. Prevalent HF determined by ICD coding for HF. Dialysis setting (inpatient vs outpatient) and dialysis access (among HD) at initiation were determined for patients with vs without HF. Multivariable logistic regression used to estimate odds ratios (OR) and 95% Cl for inpatient dialysis initiation and catheter use.
Results
6,812 CKD patients initiated dialysis. 2,498 had HF [71% preserved EF (HFpEF), 20% reduced EF (HFrEF), and 9% unknown EF]. Inpatient dialysis start occurred in 18.5% with HF vs 9.6% without HF. Catheter use at dialysis start occurred in 58.5% with HF vs 51.9% without HF. Inpatient dialysis start OR (95% Cl) were 1.73 (1.30, 2.29), 1.42 (1.22, 1.66), and 1.45 (1.17, 1.79) for HF unknown EF, HFpEF, and HFrEF compared to no HF. Inpatient dialysis start OR were 1.46 (1,26, 1.69), 0.69 (0.51, 0.93), 0.99 (0.88, 1.13), 1.54 (1.32, 1.80), 1.28 (1.11, 1.47), 1.44 (1.18, 1.77), and 0.72 (0.59, 0.89) for HF vs no HF, age>70, female, AFib, CAD, Charlson score>5, and education level 76-100%, respectively. Catheter start OR were 1.04 (0.99, 1.10), 0.85 (0.76, 0.95), 1.04 (0.99, 1.10), 1.21 (1.14, 1.29), 0.98 (0.93, 1.04), 1.20 (1.12, 1.29), and 0.86 (0.79, 0.93) for HF vs no HF, age>70, female, Afib, CAD, Charlson score>5, and education level 76-100%.
Conclusion
HF patients were more likely to start dialysis inpatient. HFrEF was associated with inpatient and catheter at dialysis start. Our findings question whether CKD patients with HF may benefit from earlier and differential dialysis transition strategies.