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Kidney Week

Abstract: FR-PO631

Association Between Sickle Cell Disease and Mortality and Hospitalizations Among In-Center Hemodialysis Patients

Session Information

Category: Genetic Diseases of the Kidneys

  • 1202 Genetic Diseases of the Kidneys: Non-Cystic

Authors

  • Blankenship, Derek M., Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Garrison, Adam M., Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Kotanko, Peter, Research Division, Renal Research Institute, New York, New York, United States
  • Raimann, Jochen G., Research Division, Renal Research Institute, New York, New York, United States
  • Han, Hao, Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Usvyat, Len A., Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Epstein, Murray, Division of Nephrology, University of Miami Miller School of Medicine, Miami, Florida, United States
  • Olaniran, Kabir O., Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, United States
  • Maddux, Franklin W., Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts, United States
Background

Sickle cell disease (SCD) is the most common hemoglobinopathy and genetic disorder worldwide, and a significant cause of end stage kidney disease (ESKD). Despite this, our understanding of adverse outcomes in SCD patients undergoing in-center hemodialysis (ICHD) is limited by small sample sizes, non-granular data and significantly different control groups resulting in residual confounding. The purpose of this preliminary study was to assess mortality and hospitalizations within a SCD patient population treated with ICHD for at least 6 months.

Methods

This retrospective study identified SCD and non-SCD patients receiving ICHD treatment from Fresenius Kidney Care (FKC) between 1-1-2017 and 12-31-2021. The baseline period was considered the first 6 months of treatment at FKC. Incident and prevalent ESKD status was defined as less than or more than 4 months since first dialysis date at the start of baseline, respectively. 602 incident and 541 prevalent SCD patients were matched to non-SCD controls using propensity score matching with confounders including incidence/prevalence status (exact match), sex, race, ethnicity, age, and vascular access type. All-cause mortality was analyzed using the Cox proportional hazards model, with the number and duration of hospitalizations being modeled using generalized estimating equations with a Poisson distribution and log link function.

Results

a) Incident Patients:
Compared to matched controls, incident SCD patients were 45% more likely to pass away at any given time point (p<0.001). SCD patients also had higher rates of hospitalizations per year (2.8 vs 1.6, p<0.001) and days hospitalized per year (8.2 vs 4.2, p< 0.001) than controls.
b) Prevalent Patients:
Compared to matched controls, prevalent SCD patients were 23% more likely to pass away at any given time point (p< 0.023). SCD patients also had higher rates of hospitalizations per year (2.8 vs 1.6, p<0.001) and days hospitalized per year (9.6 vs 5.0, p< 0.001) than controls.

Conclusion

This preliminary study provided evidence that SCD patients who have received ICHD treatments for at least 6 months remain at an elevated risk for all-cause mortality and hospitalizations compared to similar, non-SCD patients. The all-cause mortality risk was attenuated by prevalent status.