Dialysis provider and outcomes among United States veterans who transition to dialysis

Elani Streja, Csaba Kovesdy, Melissa Soohoo, Yoshitsugu Obi, Connie M. Rhee, Christina Park, Joline L.T. Chen, Tracy Nakata, Danh V. Nguyen, Alpesh N. Amin, Steven J. Jacobsen, John J. Sim, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and objectives Veterans with ESKD initiate dialysis under the Veterans Health Administration (VHA), an integrated health system, or are outsourced to non-VHA providers. It is unknown whether outcomes differ according to their dialysis provider at initiation. We sought to evaluate the association between dialysis provider and mortality and hospitalization among United States veterans initiating dialysis. Design, setting, participants, & measurements Among 68,727 United States veterans who initiated dialysis in 2007– 2014, we examined the association of dialysis provider (VHA versus non-VHA) at initiation with mortality and hospitalization rates in the first 12 months post-initiation. Associations were examined across adjusted models, accounting for demographics and comorbidities. Results Patients were 72±11 years, 5% were women, 24% were black, and 10% (n=7584) initiated at VHA dialysis centers. VHA dialysis center patients were younger, more likely to be black, had fewer cardiovascular comorbidities, and lower eGFR at dialysis initiation. VHA provider patients were more likely to be hospitalized in the first 12 months (adjusted incidence rate ratio, 1.10; 95% confidence interval, 1.07 to 1.14), but had lower all-cause mortality risk (adjusted hazard ratio, 0.87; 95% confidence interval, 0.83 to 0.93) in fully adjusted models. Conclusions Veteran patients initiating dialysis with a VHA dialysis provider appear to have a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at non-VHA dialysis units.

Original languageEnglish (US)
Pages (from-to)1055-1062
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number7
DOIs
StatePublished - Jul 6 2018

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Veterans
Dialysis
Veterans Health
United States Department of Veterans Affairs
Hospitalization
Mortality
Health
Comorbidity
Confidence Intervals
Demography

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Dialysis provider and outcomes among United States veterans who transition to dialysis. / Streja, Elani; Kovesdy, Csaba; Soohoo, Melissa; Obi, Yoshitsugu; Rhee, Connie M.; Park, Christina; Chen, Joline L.T.; Nakata, Tracy; Nguyen, Danh V.; Amin, Alpesh N.; Jacobsen, Steven J.; Sim, John J.; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 13, No. 7, 06.07.2018, p. 1055-1062.

Research output: Contribution to journalArticle

Streja, E, Kovesdy, C, Soohoo, M, Obi, Y, Rhee, CM, Park, C, Chen, JLT, Nakata, T, Nguyen, DV, Amin, AN, Jacobsen, SJ, Sim, JJ & Kalantar-Zadeh, K 2018, 'Dialysis provider and outcomes among United States veterans who transition to dialysis', Clinical Journal of the American Society of Nephrology, vol. 13, no. 7, pp. 1055-1062. https://doi.org/10.2215/CJN.12951117
Streja, Elani ; Kovesdy, Csaba ; Soohoo, Melissa ; Obi, Yoshitsugu ; Rhee, Connie M. ; Park, Christina ; Chen, Joline L.T. ; Nakata, Tracy ; Nguyen, Danh V. ; Amin, Alpesh N. ; Jacobsen, Steven J. ; Sim, John J. ; Kalantar-Zadeh, Kamyar. / Dialysis provider and outcomes among United States veterans who transition to dialysis. In: Clinical Journal of the American Society of Nephrology. 2018 ; Vol. 13, No. 7. pp. 1055-1062.
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abstract = "Background and objectives Veterans with ESKD initiate dialysis under the Veterans Health Administration (VHA), an integrated health system, or are outsourced to non-VHA providers. It is unknown whether outcomes differ according to their dialysis provider at initiation. We sought to evaluate the association between dialysis provider and mortality and hospitalization among United States veterans initiating dialysis. Design, setting, participants, & measurements Among 68,727 United States veterans who initiated dialysis in 2007– 2014, we examined the association of dialysis provider (VHA versus non-VHA) at initiation with mortality and hospitalization rates in the first 12 months post-initiation. Associations were examined across adjusted models, accounting for demographics and comorbidities. Results Patients were 72±11 years, 5{\%} were women, 24{\%} were black, and 10{\%} (n=7584) initiated at VHA dialysis centers. VHA dialysis center patients were younger, more likely to be black, had fewer cardiovascular comorbidities, and lower eGFR at dialysis initiation. VHA provider patients were more likely to be hospitalized in the first 12 months (adjusted incidence rate ratio, 1.10; 95{\%} confidence interval, 1.07 to 1.14), but had lower all-cause mortality risk (adjusted hazard ratio, 0.87; 95{\%} confidence interval, 0.83 to 0.93) in fully adjusted models. Conclusions Veteran patients initiating dialysis with a VHA dialysis provider appear to have a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at non-VHA dialysis units.",
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AU - Streja, Elani

AU - Kovesdy, Csaba

AU - Soohoo, Melissa

AU - Obi, Yoshitsugu

AU - Rhee, Connie M.

AU - Park, Christina

AU - Chen, Joline L.T.

AU - Nakata, Tracy

AU - Nguyen, Danh V.

AU - Amin, Alpesh N.

AU - Jacobsen, Steven J.

AU - Sim, John J.

AU - Kalantar-Zadeh, Kamyar

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N2 - Background and objectives Veterans with ESKD initiate dialysis under the Veterans Health Administration (VHA), an integrated health system, or are outsourced to non-VHA providers. It is unknown whether outcomes differ according to their dialysis provider at initiation. We sought to evaluate the association between dialysis provider and mortality and hospitalization among United States veterans initiating dialysis. Design, setting, participants, & measurements Among 68,727 United States veterans who initiated dialysis in 2007– 2014, we examined the association of dialysis provider (VHA versus non-VHA) at initiation with mortality and hospitalization rates in the first 12 months post-initiation. Associations were examined across adjusted models, accounting for demographics and comorbidities. Results Patients were 72±11 years, 5% were women, 24% were black, and 10% (n=7584) initiated at VHA dialysis centers. VHA dialysis center patients were younger, more likely to be black, had fewer cardiovascular comorbidities, and lower eGFR at dialysis initiation. VHA provider patients were more likely to be hospitalized in the first 12 months (adjusted incidence rate ratio, 1.10; 95% confidence interval, 1.07 to 1.14), but had lower all-cause mortality risk (adjusted hazard ratio, 0.87; 95% confidence interval, 0.83 to 0.93) in fully adjusted models. Conclusions Veteran patients initiating dialysis with a VHA dialysis provider appear to have a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at non-VHA dialysis units.

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