Poonawalla Insiya, Barve Kanchan, Cockrell Meghan, Agarwal Amal, Casebeer Adrianne W, Dixon Suzanne W, Li Yong
Humana Healthcare Research Inc, 500 W Main St, Louisville, KY 40202. Email:
Am J Manag Care. 2023 Feb;29(2):81-87. doi: 10.37765/ajmc.2023.89316.
To evaluate the association of dialysis transition planning factors (eg, nephrologist care, vascular access placement, place of dialysis) with inpatient (IP) stays, emergency department (ED) visits, and mortality.
Retrospective cohort study.
We used the Humana Research Database to identify 7026 patients with a diagnosis of end-stage renal disease (ESRD) in 2017 who were enrolled in a Medicare Advantage Prescription Drug plan with at least 12 months preindex enrollment, with first ESRD evidence as the index date. Patients with kidney transplant, hospice election, or dialysis preindex were excluded. Transition-to-dialysis planning was defined as optimal (vascular access placed), suboptimal (nephrologist care, but no vascular access), or unplanned (first dialysis in IP stay or ED visit).
The cohort was 41% female and 66% White, with a mean age of 70 years. Optimally planned, suboptimally planned, and unplanned transition to dialysis occurred for 15%, 34%, and 44% of the cohort, respectively. Among patients with preindex chronic kidney disease (CKD) stages 3a and 3b, 64% and 55%, respectively, had an unplanned dialysis transition. For patients with preindex CKD stages 4 and 5, 68% and 84%, respectively, had a planned transition. In adjusted models, patients with a suboptimally or optimally planned transition were 57% to 72% less likely to die, 20% to 37% less likely to experience an IP stay, and 80% to 100% more likely to experience an ED visit than patients with an unplanned dialysis transition.
A planned transition to dialysis was associated with reduced odds of IP stays and lower mortality.
评估透析过渡计划因素（如肾病专家护理、血管通路置入、透析地点）与住院（IP）时间、急诊科（ED）就诊次数及死亡率之间的关联。
回顾性队列研究。
我们使用Humana研究数据库，确定了2017年诊断为终末期肾病（ESRD）的7026名患者，这些患者参加了医疗保险优势处方药计划，且索引前至少有12个月的参保期，以首次出现ESRD证据的日期作为索引日期。排除接受肾移植、选择临终关怀或索引前已开始透析的患者。透析过渡计划被定义为最佳（已置入血管通路）、次优（有肾病专家护理，但未置入血管通路）或无计划（在住院期间或急诊科就诊时首次进行透析）。
该队列中41%为女性，66%为白人，平均年龄70岁。分别有15%、34%和44%的队列患者以最佳计划、次优计划和无计划的方式过渡到透析。在索引前慢性肾病（CKD）3a期和3b期的患者中，分别有64%和55%的患者无计划地过渡到透析。对于索引前CKD 4期和5期的患者，分别有68%和84%的患者进行了计划过渡。在调整模型中，与无计划透析过渡的患者相比，计划过渡为次优或最佳的患者死亡可能性降低57%至72%，住院可能性降低20%至37%，急诊科就诊可能性增加80%至100%。
有计划地过渡到透析与住院时间缩短和死亡率降低相关。
