Nondialytic Care vs Dialysis Transition on Hospitalization: Outcomes in Veterans With Advanced Chronic Kidney Disease
Among 26,040 propensity-matched US veterans with advanced chronic kidney disease, those who transitioned to dialysis were hospitalised about 64% more often and spent about 71% more days in hospital than those managed without dialysis. Earlier dialysis starts were associated with progressively higher hospitalisation rates.
Background
Dialysis is the predominant treatment paradigm for patients with advanced chronic kidney disease transitioning to end-stage kidney disease, but it may be associated with high early mortality, health care utilisation, and withdrawal. This study compared hospitalisation outcomes between nondialytic care and dialysis.
Study design
A national cohort of US veterans with advanced chronic kidney disease (at least two estimated glomerular filtration rates below 25 mL/min per 1.73 m2 separated by at least 90 days, from October 1, 2010 to September 30, 2019) was categorised by receipt of dialysis versus nondialytic care, defined as those who did versus did not receive dialysis within 2 years of their index estimated glomerular filtration rate. Propensity score matching produced a 1:1 matched cohort of 13,020 nondialytic and 13,020 dialysis patients.
Key findings
Using nondialytic care as the reference, dialysis transition was associated with higher rates of hospitalisation (incident rate ratio 1.64, 95% CI 1.61 to 1.66) and higher rates of days hospitalised (1.71, 95% CI 1.70 to 1.72). Among hospitalised patients, dialysis was associated with longer average length of stay (8.6 versus 8.1 days). In secondary analyses of the timing of dialysis transition, incrementally earlier transitions were associated with increasingly higher hospitalisation rates, with similar patterns for days hospitalised and length of stay.
Clinical implications
The findings quantify a hospitalisation burden associated with dialysis transition that is relevant to shared decision-making in advanced chronic kidney disease, particularly for older or comorbid patients weighing conservative kidney management. As an observational comparison, residual confounding by indication cannot be excluded.
Category
News
Source
Mayo Clinic Proceedings
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