Nondialytic Care vs Dialysis Transition on Hospitalization: Outcomes in Veterans With Advanced Chronic Kidney Disease

OBJECTIVE To compare the effects of nondialytic care vs dialysis on hospitalization outcomes in advanced chronic kidney disease (CKD), given that dialysis, as the predominant treatment paradigm for patients with advanced CKD transitioning to end-stage kidney disease, may be associated with high early mortality, health care utilization, and withdrawal. PATIENTS AND METHODS We examined a national cohort of veterans with advanced CKD (≥2 estimated glomerular filtration rates <25 mL/min per 1.73 m2 separated by ≥90 days from October 1, 2010, to September 30, 2019) categorized according to receipt of dialysis vs nondialytic care, defined as those who did vs did not receive dialysis within 2 years of their index estimated glomerular filtration rate. Propensity score matching was used to account for differences in baseline characteristics across exposure groups. We examined associations of nondialytic care vs dialysis with hospitalization rates and rates of days hospitalized (separately) using Poisson regression. Among hospitalized patients, we examined associations with length of stay (LOS) using linear mixed-effects models. RESULTS In the 1:1 propensity score-matched cohort of 13,020 nondialytic and 13,020 dialysis patients, dialysis transition was associated with higher rates of hospitalization and days hospitalized (reference: nondialytic care): incident rate ratios (95% CIs), 1.64 (1.61 to 1.66) and 1.71 (1.70 to 1.72), respectively. Dialysis was also associated with longer average LOS vs nondialytic care: 8.6 vs 8.1 days, respectively. In secondary analyses of timing of dialysis transition, incrementally earlier dialysis transitions were associated with increasingly higher hospitalization rates vs nondialytic care, with similar patterns observed for rates of days hospitalized and LOS. CONCLUSION Compared with nondialytic care, dialysis was associated with higher rates of hospitalization and days hospitalized and longer LOS.