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Kidney Week

Abstract: FR-PO456

Impact of Inpatient vs. Outpatient Dialysis Transition on Survival in a National Cohort of Advanced CKD Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yoon, Ji Hoon, University of California Irvine School of Medicine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States
  • Narasaki, Yoko, University of California Irvine School of Medicine, Irvine, California, United States
  • You, Seungsook, University of California Irvine School of Medicine, Irvine, California, United States
  • Daza Aguilar, Andrea C., University of California Irvine School of Medicine, Irvine, California, United States
  • Nguyen, Danh V., University of California Irvine School of Medicine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine School of Medicine, Irvine, California, United States
Background

Large population-based studies show advanced CKD patients transitioning to ESKD have high mortality in the first few months of dialysis initiation. It is unclear whether transitioning to dialysis in the inpatient vs. outpatient setting is associated with better survival in incident ESKD patients.

Methods

We examined advanced CKD patients (≥2 eGFRs <25 separated by ≥90 days) who transitioned to within 2-years of their 1st (index) eGFR <25 over 1/1/07-6/30/20 from the Optum Labs Data Warehouse, which contains de-identified administrative claims, including medical/pharmacy claims and enrollment records for commercial/Medicare Advantage enrollees, and EHR data. We compared all-cause mortality in patients who transitioned to dialysis in the inpatient vs. outpatient setting matched by propensity score (PS) in a 1:1 ratio with a caliper distance of ≤0.2 to address confounding by indication in Cox models.

Results

Among 20,655 patients who were PS-matched to 20,655 patients who transitioned to dialysis in the outpatient vs. inpatient settings, respectively, outpatient dialysis transition was associated with lower mortality risk vs. inpatient dialysis transition: HR (95%CI) 0.77 (0.75-0.79). Similar findings were observed in sensitivity analyses doubly-adjusted for PS-score covariates (ref: inpatient dialysis transition): HR (95%CI) 0.73 (0.71-0.75) for outpatient dialysis transition.

Conclusion

In a national cohort of advanced CKD patients transitioning to ESKD, outpatient dialysis was associated with better survival compared with inpatient dialysis transition. Further studies are needed to determine the factors contributing to differential survival, as well as the comparative effectiveness of inpatient vs. outpatient dialysis transition on other ESKD outcomes (patient-reported endpoints, healthcare costs).

Funding

  • NIDDK Support