1387-P: Impact of Dialysis Modality on In-Hospital Outcomes of Diabetic Ketoacidosis: A Nationwide Analysis (2017–2020)

Introduction and Objective: Diabetic Ketoacidosis (DKA) is a life-threatening complication in patients with End-Stage Renal Disease (ESRD). Theoretical concerns exist that the glucose-rich dialysate used in peritoneal dialysis (PD) may exacerbate hyperglycemia or complicate acidosis resolution compared to hemodialysis (HD). Methods: This is a retrospective cohort study using the National Inpatient Sample (NIS) from 2017-2020. Adult hospitalizations (age ≥18) with a primary diagnosis of DKA and a secondary diagnosis of ESRD were identified. Patients were stratified into PD and HD groups using ICD-10 procedure and Z-codes. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS) and racial distribution. Survey-weighted multivariate logistic and linear regression models were used to adjust for age, sex, race, obesity, Elixhauser comorbidities. Results: The study identified 13,810 hospitalizations comprising 12,535 (90.8%) on HD and 1,275 (9.2%) on PD. Baseline age and sex were similar between groups. However, significant racial disparities were observed: African American patients comprised 15% of the HD cohort but only 9.8% of the PD cohort (p=0.013). In-hospital mortality was 1.7% for HD and 1.2% for PD. After multivariateadjustment, there was no statistically significant difference in mortality between PD and HD (Adjusted Odds Ratio 0.68; 95% CI 0.20-2.33; p=0.538). Similarly, there was no significant difference in hospital LOS (Adjusted Difference -0.11 days; 95% CI -0.73 to 0.52; p=0.741). Conclusion: Despite theoretical concerns, this nationwide analysis found no significant differences in in-hospital mortality or length of stay between PD and HD patients. These findings suggest that despite the physiological glucose load associated with PD, it remains a safe modality for managing DKA admissions. Additionally, underrepresentation of African American patients in the PD population highlights ongoing disparities in access to home dialysis. Disclosure A. Vanaparti: None. G. Capriles: None. A. Marques: None. H.M. Baloch: None.