Abstract: TH-PO0995
Clinical Outcomes for Emergent vs. Scheduled Hemodialysis in a Safety-Net Hospital
Session Information
- Diversity and Equity in Kidney Health
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Balakrishnan, Naveen Kishore, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Smartt, Jillian L., Parkland Health, Dallas, Texas, United States
- Saxena, Ramesh, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Harms, Michael, Parkland Health, Dallas, Texas, United States
- Patel, Jiten, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Bhavan, Kavita P, Parkland Health, Dallas, Texas, United States
Background
Emergent hemodialysis (HD) is associated with higher cost of care and poor clinical outcomes, including lower quality-of-life measures and increased mortality. At Parkland Health, Nguyen et al. described increased mortality rates among patients receiving emergent vs. scheduled HD (17% vs 3%) at 1 year. Patients transitioned from emergent to scheduled HD in this study had an estimated annual cost reduction of $72,000/patient. Parkland subsequently instituted a program to provide scheduled HD at Fresenius utilizing the county-funded charity coverage system. This unique model within a safety-net health system is the first of its kind to our knowledge. We evaluate the clinical outcomes for patients in this system.
Methods
Retrospective cross-sectional analysis of incident HD patients continuing emergent HD vs patients transitioned from emergent HD into a scheduled HD program at Fresenius between September 2018 – December 2021. Demographics, Emergency Department (ED) visits, hospitalizations, outpatient visits, and mortality were evaluated. Multivariable logistic regression was used to evaluate differences in mortality and Welch’s t-test for other outcomes.
Results
64 emergent and 299 scheduled HD patients were identified. The scheduled HD cohort was found to have more women and more patients with indigent hospital financial coverage. Patients receiving scheduled HD had higher rates of diabetes and lower rates of substance use, and increased outpatient follow-up in the year prior to HD initiation. ED visits and hospitalizations were higher in the emergent HD population at both 30 days and 1 year (p < 0.001).
Conclusion
Patients enrolled for scheduled HD through this novel program between Parkland Health and Fresenius had better clinical outcomes, including reduced ED visits and hospitalizations when compared to emergent HD patients.