Abstract: SA-PO1050
Hospital-Level Variation in 30-Day Mortality Among Patients Receiving Kidney Replacement Therapy in a Brazilian 21-Hospital Private Network
Session Information
- Hemodialysis: Risk Factors, Epidemiology, and Outcomes
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
- Carvalho, Maria Fernanda Camargo, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
- Santos, Marcelo Moreira, Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
- Koch Nogueira, Paulo C., Hospital Samaritano de Sao Paulo, São Paulo, SP, Brazil
Background
Kidney replacement therapy (KRT) in hospitalized patients is associated with high mortality, particularly in acute settings. However, outcome variability across hospital networks remains poorly described in South America. Understanding this variation may identify opportunities for quality improvement.
Methods
We conducted a retrospective multicenter cohort of adult and pediatric patients receiving KRT across 21 hospitals from a Brazilian private health care network between 2019 and 2025. The primary outcome was 30-day in-hospital mortality. Patients were classified by chronic kidney disease (CKD) status, KRT modality, age group, and anonymized hospital state. Because proportional hazards were not fully met, robust Poisson regression estimated adjusted relative risks (aRRs) and 95% confidence intervals (CIs)
Results
We included 14,721 hospitalizations requiring KRT; 30-day mortality was 14.7%. In crude analyses, mortality was higher without prior CKD than with CKD (31.4% vs. 5.6%; RR 5.8, 95% CI 5.3–6.4). Continuous KRT had the highest crude mortality (55.6%; RR 8.1, 95% CI 7.4–8.7), followed by mixed modalities (24.1%; RR 3.5, 95% CI 3.1–3.9), versus conventional KRT (6.9%). In the multivariable model, absence of CKD, continuous KRT, mixed KRT, peritoneal dialysis, adult age group, and State 3 were associated with higher mortality. The strongest association was for continuous versus conventional KRT (aRR 4.37, 95% CI 3.90–4.90), followed by absence of CKD versus CKD (aRR 3.01, 95% CI 2.66–3.41). Adult age group (aRR 1.88, 95% CI 1.50–2.35) and State 3 versus unit 1 (aRR 1.37, 95% CI 1.23–1.53) were also associated with higher mortality
Conclusion
Marked variability in 30-day mortality suggests opportunities for system-level quality improvement. The high mortality without prior CKD and with continuous KRT likely reflects greater acute illness severity and underscores the need for early risk stratification, standardized care pathways, and network-based monitoring.