Hospitalizations lower for patients with advanced CKD who choose conservative management
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ORLANDO — Patients with advanced chronic kidney disease who choose conservative management have lower hospitalization rates vs. patients who choose dialysis, according to a study presented at ASN Kidney Week.
“Given evidence that dialysis results in greater health care utilization and morbidity among certain subgroups, there is rising interest in conservative management (CM) as an alternative patient-centered treatment strategy for advanced CKD,” Connie M. Rhee, MD, associate professor of medicine and associate professor of public health in the school of medicine at the University of California at Irvine, and colleagues wrote in their study abstract. “Little is known about the comparative effectiveness of CM vs. dialysis on hospitalization outcomes across different races/ethnicities.”
For the study, the researchers reviewed data on hospitalization rates for 309,188 patients with advanced CKD who were treated either with CM or dialysis between January 2007 and June 2020. Patients were categorized according to receipt of CM, “defined as those who did not receive dialysis within 2 years of the index eGFR ([first] eGFR of less than 25 mL/min per 1.73 m2) vs. receipt of dialysis parsed as late vs. early dialysis transition (eGFRs 15 mL/min per 1.73 m2 vs. 15 [mL/min per 1.73 m2] at dialysis initiation),” Rhee and colleagues wrote.
Results showed that 55% of patients with advanced CKD in the study had at least one hospitalization within 2 years, but those patients who started dialysis vs. choosing conservative management demonstrated the highest rates of hospitalizations across all age groups.
The most common causes of hospitalization in both the CM and dialysis groups were congestive heart failure, respiratory illness or hypertension-related issues.
Patients who were categorized as Hispanic, non-Hispanic white or non-Hispanic Black who were on dialysis and initiated dialysis early had higher hospitalization rates vs. those who had CM, Rhee and colleagues said. Among Asian patients, late dialysis starts led to higher hospitalization rates than early dialysis, particularly in older age groups, they said.
“We observed differential relationships between CM vs. dialysis on hospitalization rates across race/ethnicity and age,” Rhee and colleagues concluded. “Further research is needed to determine which patients are optimal candidates for CM vs. dialysis using a personalized approach.”
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Rhee CM, et al. SA-OR33. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
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