Abstract: SA-PO1104
Predialysis Care (pdCKD) and Early Outcomes After Dialysis Initiation: The Mediating Role of Vascular Access and Modifiable Factors at Dialysis Start in a European Multicountry Cohort
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Neri, Luca, Renal Research Institute, New York, New York, United States
- Carioni, Paola, Renal Research Institute, New York, New York, United States
- Bellocchio, Francesco, Renal Research Institute, New York, New York, United States
- Constantinescu, Liviu, Fresenius Medical Care AG, Bad Homburg, HE, Germany
- Usvyat, Len A., Renal Research Institute, New York, New York, United States
- Guinsburg, Adrian M., Fresenius Medical Care AG, Bad Homburg, HE, Germany
Background
PdCKD has been associated with improved outcomes after dialysis initiation. We evaluated whether pdCKD is associated with reduced mortality and hospitalization after dialysis initiation and the potential mediating role of modifiable factors.
Methods
We included 17,230 incident dialysis patients (pts) from 250 NephroCare clinics in Czech Republic, Italy, Poland, Romania, Slovakia and Spain. PdCKD was defined as ≥1 CKD-related clinical encounter 91 to 210 days before dialysis initiation or creation of permanent vascular access ≥30 days prior. Outcomes were all-cause mortality and hospitalization rates at 3, 6, and 12 months after dialysis start. We assessed association between pdCKD and outcomes with sequential adjustment: 1) non-modifiable factors only; 2) model 1 plus a subset of modifiable factors; 3) model 2 plus arteriovenous fistula (AVF) use at dialysis initiation.
Results
PdCKD was present in 6,990 pts (41%) with marked cross-country heterogeneity (29–62%). Pts receiving pdCKD were more likely to initiate dialysis with AVF (77% vs 2%) and more likely to start with optimal nutrition, inflammation, hydration, anemia and bone metabolism status. After adjustment for non-modifiable factors, pdCKD was strongly associated with lower 1-year mortality and hospitalization (table 1). Associations attenuated in model 2 after inclusion of modifiable factors and were no longer significant after further adjustment for AVF (model 3). AVF use was the single most impacting modifiable predictor of mortality and hospitalization rate at 12 months. Consistent patterns were observed at 3 and 6 months in sensitivity analyses.
Conclusion
Exposure to pdCKD was associated with markedly lower mortality and hospitalization after dialysis initiation. This benefit was largely mediated through modifiable factors and use of AVF at dialysis initiation. Ensuring early nephrology referral and structured CKD follow-up that culminates in optimal dialysis initiation with a functional AVF may be the most impactful lever to improve early post-dialysis outcomes.
Acknowledgment
The authors thank the country medical directors Katarina Nehézová (Czech Republic), Mario Cioffi (Italy), Wojciech Marcinkowski (Poland), Dan Munteanu (Romania), Jaroslav Rosenberger (Slovakia), and Maria Eva Baro Salvador (Spain), on behalf of all physicians, nurses, and clinical staff at the NephroCare clinics, for their contribution to patient care and data collection.