Adverse Clinical Events in Patients on Maintenance Dialysis

Boston—Clinical adverse events among patients with end-stage renal disease (ESRD) on maintenance dialysis are uncommon. However, according to Dustin Little, MD, and colleagues, an improved understanding of the rates of adverse events in that patient population could be of benefit to patients, providers, and other stakeholders.

Utilizing data from the US Renal Data System, the researchers conducted a retrospective cohort study to examine rates of adverse events in patients with ESRD on maintenance dialysis. Results of the study were reported during a poster session at the NKF Spring Clinical Meetings in a poster titled Rates of Clinical Adverse Events in ESRD Patients on Maintenance Dialysis.

The study included 278,115 Medicare patients with ESRD who initiated maintenance dialysis between January 1, 2009, and June 1, 2013. Adverse events were identified from Medicare inpatient claims, using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The follow-up period was censored at transplant, death, or December 31, 2013. The primary outcome of interest was rates of adverse events.

Adverse events were identified as  (1) primary discharge diagnosis, or (2) any one of the discharge diagnoses. Incidence rate ratios (IRRs) were used to report incidence rates; rates were compared by race (blacks vs whites).

Mean age of the cohort was 64.3 years, 55.7% were men, 27.2% were black, and 68.2% were white. Follow-up continued for a median of 1.9 years, for total person-time of 777,760 years. The rate of pancreatitis as the primary discharge diagnosis was 7.01 (95% confidence interval [CI], 6.82-7.20) events per 1000 person years. The IRR of pancreatitis for black versus white race was 1.70 (95% CI, 1.61-1.79).

“We contextualize rates for important but uncommon adverse clinical events using a national-level database of US Medicare primary ESRD patients on maintenance dialysis,” the researchers summarized.

Source: Little D, Houser M, James G, Nee R. Rates of clinical adverse events in ESRD patients on maintenance dialysis. Abstract of a poster presented at the National Kidney Foundation 2019 Spring Clinical Meetings, May 8-12, 2019, Boston, Massachusetts.