#6448 IMPACT OF PRE-DIALYSIS FOLLOW-UP ON OUTCOMES IN DIALYSIS PATIENTS
Authors: Guinsburg Adrian , Bessone Maria Inés Díaz , Caseiro Mauro 
Published: June 2023

Abstract

Background and Aims
Pre-dialysis care aims to slow down the decline in kidney function and to prepare patients for their potential start of renal replacement therapy. Patients who received attention earlier showed reduced mortality and hospitalization, better uptake of peritoneal dialysis, and earlier placement of arteriovenous fistula for hemodialysis. The objective of this study is to analyze the impact of pre-dialysis care in dialysis patients from Fresenius Medical Care Latin America (FME LatAm).

Method
Patients incident to dialysis that started treatment at FME LatAm between January 2019 and December 2022 were included in this retrospective observational study. They were classified according to whether they received pre-dialysis care or not as CKD (more than 10 days of follow up;) or No CKD (less than 10 days). CKD group was subclassified regarding the length of stay in pre-dialysis care in 10 to 45 days (10-45), 45 to 90 days (45–90), and more than 90 days (&gt;90). Demographic variables, vascular access, and lab variables were compared between CKD and No CKD, and within subgroups during the observation period. Values are expressed in mean ± SD. Values compared using Student t-test or ANOVA accordingly.

Results
CKD patients were older than No CKD (CKD: 61.5 ± 16.6 vs NoCKD: 60.6 ± 17.2; p = 0.02), with lower male prevalence (CKD: 57.5% vs NoCKD: 60.2%; p=0.001). No significative differences in prevalence of diabetes were found. Patients under pre-dialysis treatment showed a higher rate of PD referrals (CKD: 44.6% vs NoCKD: 7.3%; p &lt;0.0001). Regarding vascular access, a higher percentage of CKD patients started dialysis with definitive access (AVF or AVG) (CKD: 47.9% vs NoCKD: 31.5%; p &lt;0.0001). In the same way, prevalence of definitive accesses was higher in patients with longer CKD stay (10-45: 38.4%, 45-90: 57.3%, &gt;90: 50.2%; p&lt;0.0001). Within patients who started treatment with a catheter, a higher percentage of CKD patients already had a fistula or graft performed at treatment start (CKD: 7.3% vs NoCKD: 2.7%; p &lt;0.0001). EPO prescription was higher as the time of follow-up was longer (10-45: 3.3%, 45-90: 7%, &gt;90: 14.9%; p&lt;0.0001). As expected for CKD patients haemoglobin was higher and ferritin was lower (Table 1). Though TSAT, Calcium, and Albumin were significative different between CKD and No CKD, the difference was not clinically relevant. Phosphorus and iPTH was higher in CKD patients and creatitine clearence calculated by MDRD was lower in those patients, opposite of expected (Table 1).

Conclusion
Older and male patients are more likely to have CKD follow-up. Pre-dialysis treatment has a deep impact on PD referral, EPO prescription, type of vascular access at admission, and ready-made vascular access at treatment start. Some laboratory results were not as expected, maybe due to non proper medication accessibility or inadequate financial support at predialysis stages. Even though, CKD follow-up is crucial to prepare patients for a better start of renal replacement therapy.