Abstract: TH-PO1282
Outcomes for Veterans in Veterans Affairs (VA) and VA Community Care Dialysis Settings Favor VA and Were Not Impacted by the COVID-19 Pandemic
Session Information
- Late-Breaking Research Posters
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Wang, Virginia, Durham VA Health Care System, Durham, North Carolina, United States
- Coffman, Cynthia, Duke University, Durham, North Carolina, United States
- Jiang, Lan, Providence VA Medical Center, Providence, Rhode Island, United States
- Goodwin, Kaitlyn B., Durham VA Health Care System, Durham, North Carolina, United States
- Maciejewski, Matthew L., Durham VA Health Care System, Durham, North Carolina, United States
- O'Hare, Ann M., VA Puget Sound Health Care, Seattle, Washington, United States
- Diamantidis, Clarissa Jonas, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Trivedi, Amal, Providence VA Medical Center, Providence, Rhode Island, United States
Background
Veterans with ESKD, a population disproportionately affected by social disadvantage and severe illness, rely on VA-financed care delivered by VA and VA Community Care (VACC) providers. Heavy reliance on care across VA and non-VA systems may increase care fragmentation and adverse outcomes, which likely worsened during the COVID-19 pandemic. We assessed changes in hospital use and mortality, overall and by disparity indicators, among Veterans receiving dialysis in VA and VACC during the pandemic.
Methods
In a cohort of Veterans receiving VA-financed hemodialysis, we examined differential changes in hospitalization and mortality between Veterans' most common VA or VACC dialysis setting. We compared outcomes by dialysis setting across 3 time periods: Jan 2018-Feb 2020 (pre-COVID), pandemic before vaccine March 2020-Dec 2020 (acute), and post-vaccine COVID Jan 2021-Jan 2022 (recovery). Differences in changes in monthly mortality across time periods were also examined by race (White, Black, Hispanic/Other). Changes were estimated with marginal structural mean models fit using inverse probability of treatment weighted generalized estimating equations to address confounding.
Results
Of 34,398 patients, 29% received dialysis in VA and 71% in VACC, with VA dialysis patients having greater comorbidity. After weighted adjustment, estimated monthly rates of hospital days for Veterans in VA vs. VACC dialysis did not differ (2.3 vs. 2.0 days) and did not change across COVID periods (p=0.36). However, VA dialysis patients had significantly lower odds of mortality than VACC in all COVID time periods (OR=1.1, 95% CI 1.0, 1.2 pre-COVID, OR=1.2, 95% CI 1.1, 1.3 acute COVID, and OR=1.1, 95% CI 1.0, 1.2 recovery COVID era). Estimated monthly VA vs. VACC mortality was 1.5% vs. 1.6% in pre-COVID era, 1.6% vs 1.9% in acute COVID era, and 1.8% vs. 1.9% during COVID recovery. These differences did not vary across COVID time periods (p=0.43), including when examined by race (p=0.62).
Conclusion
Outcomes for Veterans receiving dialysis financed by VA were not impacted by COVID-19, which sharply contrasts with previously reported experience of patients receiving dialysis in US private sector, community settings. Mechanisms underlying the VA's pandemic experience and Veterans' lower mortality in VA dialysis clinics bears further investigation to inform system planning and outsourcing decisions.
Acknowledgment
Department of Veterans Affairs grants I01HX003574, I50HX002733.
Funding
- Veterans Affairs Support