Characteristics of patients Without renal recovery

Slides:

Advertisements

Similar presentations

Cardiovascular Implantable Electronic Device Leads & Arteriovenous Hemodialysis Access Theodore F. Saad, MD Nephrology Associates, PA Christiana Care Health.

Advertisements

Chapter 3: Clinical Indicators and Preventive Care 2014 A NNUAL D ATA R EPORT V OLUME 2: E ND -S TAGE R ENAL D ISEASE.

Chapter 2: Healthy People A NNUAL D ATA R EPORT V OLUME 2: E ND -S TAGE R ENAL D ISEASE.

Chapter 2: Identification and Care of Patients With CKD 2014 ANNUAL DATA REPORT VOLUME 1: CHRONIC KIDNEY DISEASE.

Chapter 5: Acute Kidney Injury 2014 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D ISEASE.

APPENDIX 1. D-1 New cases of diagnosed diabetes D-2.1 All cause mortality* D-2.2 Cardiovascular disease deaths* D-3 Diabetes death rate, multiple cause.

CHRONIC KIDNEY DISEASE National Healthcare Quality and Disparities Report Chartbook on Effective Treatment.

Haemodialysis Vascular Access: Recent Trends From ANZDATA Dr Kevan Polkinghorne Monash Medical Centre ANZSN September 2007.

Primary ESRD Modality in New ESRD Patients, * New Patients (%) *Reported on HCFA Medical Evidence Form USRDS 1999 IV -1.

Chapter 10 Cancer 2014 ANZDATA Registry 37th Annual Report Data to 31-Dec-2013 ANZDATA gratefully acknowledges the contributions of the Cancer Working.

2015 ANNUAL DATA REPORT V OLUME 2: E ND -S TAGE R ENAL D ISEASE Chapter 6: Mortality.

Chapter 2: Identification and Care of Patients With CKD 2015 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D ISEASE.

Chapter 5: Acute Kidney Injury 2015 A NNUAL D ATA R EPORT V OLUME 1: C HRONIC K IDNEY D ISEASE.

2015 ANNUAL DATA REPORT V OLUME 2: E ND -S TAGE R ENAL D ISEASE Chapter 2: Healthy People 2020.

2015 ANNUAL DATA REPORT V OLUME 2: E ND -S TAGE R ENAL D ISEASE Chapter 4: Vascular Access.

Date of download: 6/2/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Similar Outcomes With Hemodialysis and Peritoneal.

Date of download: 6/26/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Trends in Anemia Care in Older Patients Approaching.

USRDS USRDS 2002 adr Incident counts by initial modality figure 7.1 patients age 19 years & younger.

Analysis of Risk Factors for Early Access Failure of AVF in Patients on Hemodialysis 경희 대학교 의과대학 내과학교실 문수연, 박병조, 이향이, 정경환, 김정희, 이상호, 이태원, 임천규, 김명재.

Primary Cause of Kidney Failure in new ESRD patients at initiation, by ethnicity figure 2.1, combined.

2016 Annual Data Report, Vol 2, ESRD, Ch 5

R. Papani, A. G. Duarte, Y-L. Lin, G. Sharma

2016 Annual Data Report, Vol 2, ESRD, Ch 8

An AKI project for critically ill cancer patients

Figure 9.1 Causes of death in ESRD patients,

Burden of acute otitis media, recurrent otitis media and tympanostomy tube insertion in urban, minority children less than 7 years of age in Boston: Comparison.

2016 Annual Data Report, Vol 2, ESRD, Ch 6

Figure 10.1 Dialysis unit counts, by unit affiliation, 2011–2014

First-year death rates by modality figure 8

Odd ratio of developing kidney failure figure 1

Patient populations by study group figure 10

Trends in Use of Pulmonary Rehabilitation Among Older Adults with Chronic Obstructive Pulmonary Disease Anita C. Mercado, Shawn P. Nishi, Wei Zhang, Yong-Fang.

Chapter 2: Identification and Care of Patients With CKD

Mortality rates in incident ESRD patients figure 9

Volume 2: End-Stage Renal Disease

Volume 2: End-Stage Renal Disease

2016 Annual Data Report, Vol 1, CKD, Ch 2

2017 Annual Data Report Healthy People 2020.

Volume 2: End-Stage Renal Disease Chapter 4: Hospitalization

Volume 2: End-Stage Renal Disease

Volume 1: Chronic Kidney Disease

Chapter 7: ESRD among Children, Adolescents, and Young Adults

December 31st point prevalent counts by modality figure 3.1

2016 Annual Data Report, Vol 2, ESRD, Ch 4

Volume 1: Chronic Kidney Disease Chapter 5: Acute Kidney Injury

Hospital admissions per patient, by modality figure 5

Other interesting renal biopsy cases will be discussed.

2016 Annual Data Report, Vol 2, ESRD, Ch 14

Volume 2: End-Stage Renal Disease Chapter 4: Hospitalization

Hemoglobin, EPO, & Iron dose figure 4

2018 Annual Data Report Volume 3: Healthy People 2020

Chapter 4: Cardiovascular Disease in Patients with CKD

2018 Annual Data Report Volume 1: Chronic Kidney Disease

Volume 2: End-Stage Renal Disease

Volume 2: End-Stage Renal Disease

Volume 63, Issue 1, Pages (January 2003)

Volume 2: End-Stage Renal Disease

Chapter 2: Identification and Care of Patients with CKD

Chapter 12: End-of-life Care for Patients with ESRD:

Mortality caused by sepsis in patients with end-stage renal disease compared with the general population Mark J. Sarnak, Bertrand L. Jaber Kidney International

Fig 6.1 Frequency of ischaemic heart disease in incident patients

Fernando Valderrábano, Francisco Gómez-Campderá, Elizabeth H.P. Jones

Lynda Anne Szczech, Ira L. Lazar Kidney International

Areef Ishani, Allan J. Collins, Charles A. Herzog, Robert N. Foley

Collecting and using patient and treatment center data to improve care: Adequacy of hemodialysis and end-stage renal disease surveillance1 William M.

Attributed cause of end-stage renal disease (ESRD) among 251 patients with SLE in the Georgia Lupus Registry who progressed to ESRD (1979–2012), overall.

Presence of inpatient diagnostic codes for attributed cause of end-stage renal disease (ESRD) among 46 patients with systemic lupus erythematosus (SLE)

END STAGE RENAL DISEASE The BVI Experience

Figure 9.1.a Causes of death in ESRD patients,

Chapter 2: Identification and Care of Patients with CKD

Presentation transcript:

Characteristics of patients Without renal recovery Cessation of Renal Replacement Therapies with Improved Kidney Function in the ESRD Medicare Program The Fistula First Breakthrough Initiative Data Committee Background Results ESRD has meant “Loss of kidney function, with need for kidney replacement treatments”, however, as evidence will show, some patients may not actually be afflicted with ESRD in the first place, and may instead be individuals suffering from types of acute kidney injury. Characteristics of patients Without Renal Recovery With Renal Recovery p value No restart Restart N 181,037 (94.25%) 11,054 (5.75%) 0.010 11,053 (99.03%) 1916 (0.97%) Age (years) 63.9 ± 15.6 62.3 ± 15.6 <0.001 Male (%) 56.5 58.3 58.6 57.7 0.425 Access (%) AV Fistula (%) 14.79 1.86 7.41 AV graft (%) 3.39 0.89 1.25 Catheter (%) 80.92 96.41 90.08 Other (%) 0.90 0.84 Insurance coverage Employer (%) 93.2 6.8 Medicare Adv. (%) 94.5 5.5 0.168 Medicare (%) 94.6 5.4 48.11 55.17 Medicaid (%) 95.2 4.8 21.49 25.21 None (%) 93.9 6.1 0.087 8.21 5.17 Prior Nephrology care 56.91 24.19% 24.19 46.09 < 6months (%) 21.11 26.69 29.69 22.42 6 – 12 months (%) 36.37 40.65 38.05 > 12 months (%) 42.52 29.66 39.52 Primary diagnosis Diabetes (%) 42.94 21.38 41.54 Hypertension (%) 27.80 19.07 21.092 0.004 AIN (%) 0.17 2.02 0.26 ATN (%) 2.29 22.05 6.84 Other toxic agents (%) 0.39 1.51 0.63 0.002 Cholesterol emboli (%) 0.33 1.01 0.42 0.012 Multiple myeloma (%) 0.93 2.48 1.36 0.003 Unknown Etiology (%) 3.87 7.34 3.6 Comorbids 33.57 23.43 41.39 76.34 65.26 76.93 CHF (%) 29.78 22.08 36.95 CVA (%) 8.5 6.59 9.19 No Comorbids (%) 0.02 0.1 0.167 Multivariate model for persistent recovery of renal function Recovery Odds Ratio Std Error z P value 95% CI Age < 65 Reference Age > 65 0.870 0.023 -5.160 0.000 0.825 0.917 Male Female 0.977 0.021 -1.090 0.275 0.937 1.019 Access AV Fistula AV graft 1.847 0.232 4.890 1.444 2.361 Catheter 4.545 0.329 20.940 3.944 5.237 Other 3.535 0.473 9.430 2.719 4.596 Race White Black 0.530 0.015 -22.410 0.501 0.560 0.562 0.034 -9.520 0.499 0.633 ESRD Network ESRD Network 1 1.252 0.112 2.510 0.012 1.051 1.491 ESRD Network 2 1.151 0.091 1.770 0.076 0.985 1.345 ESRD Network 3 ESRD Network 4 1.653 0.130 6.400 1.417 1.929 ESRD Network 5 2.237 0.167 10.760 1.932 2.590 ESRD Network 6 2.298 11.460 1.993 2.649 ESRD Network 7 2.525 0.180 12.970 2.195 2.904 ESRD Network 8 0.190 12.310 2.179 2.926 ESRD Network 9 2.015 0.143 9.850 1.753 2.317 ESRD Network 10 1.673 0.138 6.250 1.424 1.965 ESRD Network 11 1.664 0.122 6.920 1.440 1.922 ESRD Network 12 2.211 0.173 10.150 1.897 2.578 ESRD Network 13 2.595 0.200 12.400 2.232 3.017 ESRD Network 14 1.502 0.111 5.510 1.300 1.737 ESRD Network 15 1.981 0.152 8.880 1.704 2.304 ESRD Network 16 1.610 5.350 1.353 1.917 ESRD Network 17 1.539 0.127 5.220 1.309 1.809 ESRD Network 18 2.037 0.146 9.940 2.344 Comorbid Hypertension 0.849 0.020 -6.890 0.811 0.890 Diabetes 0.927 0.025 -2.780 0.005 0.879 0.978 Cardiac Disease 0.812 0.019 -8.730 0.775 0.851 Insurance Medicare 0.916 0.024 -3.310 0.001 0.965 Medicaid 0.813 0.022 -7.780 0.772 0.856 No Medical coverage 0.705 0.029 -8.520 0.651 0.764 Diagnosis Unknown Etiology 1.462 0.064 8.610 1.341 1.594 Hypertensive Nephropathy 0.687 -11.730 0.645 0.732 Diabetic glomerulosclerosis 0.551 0.018 -18.700 0.517 0.586 Acute Injury 5.136 0.168 50.090 4.818 5.476 Other nephrotoxic agents 3.339 0.311 12.930 2.781 4.009 Multiple Myeloma 1.683 0.119 7.370 1.465 1.933 Methods A total of 205,399 incident ESRD hemodialysis patients from 2008 & 2009 were tracked over two years in the CMS SIMS registry. Start dates were initialized with incident dialysis. Recovery, if reported, was marked from dialysis facility updates transmitted through ESRD Networks and entered into the SIMs central repository on a daily basis. Patients who were restarted on dialysis during the period were excluded from our primary analysis. Diagnoses with highest rates of recovery of renal function With renal recovery Without renal recovery Acute interstitial nephritis 42.7% (223) 57.8% (299) Tubular necrosis 37% (2,437) 63% (4,144) Nephropathy caused by other agents 19.1% (167) 80.9% (709) Cholesterol emboli, renal emboli 15.9% (112) 84.1% (594) Other renal disorders 15.5% (409) 84.5% (594) Multiple Myeloma 14% (274) 86% (1,688) Hepatorenal syndrome 12.8% (127) 87.2% (865) Etiology uncertain 10.4% (811) 89.6% (7,001) Overall 5.8% (11,032) 94.2% (180,887) Geographical Variation in rates of Renal Recovery Discussion Conclusions In the US ESRD program 6.6% of patients experienced renal recovery with a median time to recovery of 74 days. Approx 14.5% of patients subsequently were restarted on dialysis. Patients with persistent recovery of renal function, tended to be white, below 65 years of age, with temporary accesses (catheters or other) and the etiology of their kidney disease was acute injury (AIN, ATN, cholesterol emboli or hepatorenal syndrome) or exposure to a nephrotoxic agent.