Kidney Week

Abstract: FR-PO892

Impact of Conservative Management vs. Dialysis on Hospitalization Outcomes in US Veterans with Advanced CKD

Session Information

• Geriatric Nephrology
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1300 Geriatric Nephrology

Authors

• Rhee, Connie, University of California Irvine School of Medicine, Irvine, California, United States

Connie Rhee,

• Narasaki, Yoko, University of California Irvine School of Medicine, Irvine, California, United States

Yoko Narasaki,

• Crowley, Susan T., Yale University, New Haven, Connecticut, United States

Susan T. Crowley,

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Mukamel, Dana B., University of California Irvine School of Medicine, Irvine, California, United States

Dana B. Mukamel,

• You, Seungsook, University of California Irvine School of Medicine, Irvine, California, United States

Seungsook You,

• Yoon, Ji Hoon, University of California Irvine School of Medicine, Irvine, California, United States

Ji Hoon Yoon,

• Novoa-Vargas, Alejandra, University of California Irvine School of Medicine, Irvine, California, United States

Alejandra Novoa-Vargas,

• Nguyen, Danh V., University of California Irvine School of Medicine, Irvine, California, United States

Danh V. Nguyen,

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States

Kamyar Kalantar-Zadeh,

Background

Given high early mortality rates, healthcare utilization, and withdrawal in incident dialysis subgroups, particularly those of older age or multi-morbidity, there is interest in conservative management (CM) as an alternative treatment strategy for advanced CKD. We examined the impact of CM vs. dialysis transition on hospitalization outcomes in Veterans with advanced CKD.

Methods

We examined Veterans with advanced CKD (≥2 eGFRs <25 separated by ≥90 days) treated with CM vs. dialysis (non-receipt vs. receipt of dialysis within 2-years of the 1^st eGFR <25). Patients in the dialysis group were categorized according to timing of dialysis transition, defined as earlier dialysis (ED) vs. intermediate dialysis (ID) vs. very-late dialysis (VLD) (eGFRs ≥15, 10-<15, vs. <10 at dialysis transition). We compared rates of hospitalization (primary outcome) and days hospitalized (secondary outcome) in CM vs. dialysis patients matched by propensity score (PS) in a 1:1 ratio to address confounding using Poisson regression.

Results

In PS-matched models, compared with CM, each dialysis group was associated with higher rates of hospitalization, with incrementally higher rates observed with earlier dialysis transitions: IRRs (95%CIs) 1.53 (1.50-1.56), 1.56 (1.53-1.60), and 1.75 (1.70-1.80) for VLD, ID, and ED, respectively (Fig A). Similarly, each dialysis group was associated with higher rates of days hospitalized, with incrementally higher rates observed with earlier dialysis transitions (ref: CM): IRRs (95%CIs) 1.42 (1.41-1.44), 1.55 (1.54-1.56), and 2.08 (2.06-2.10) for VLD, ID, and ED, respectively (Fig B). Similar findings were observed in sensitivity analyses doubly-adjusted for PS covariates.

Conclusion

Compared with CM, increasingly earlier dialysis transitions were associated with higher rates of hospitalization and days hospitalized. Further studies are needed to examine the comparative effectiveness of CM vs. dialysis transition on other hard endpoints and patient-centered outcomes in US Veterans.

Funding

• NIDDK Support