In the Journals

Veterans Health Administration dialysis providers linked with lower mortality rates, increased hospitalization rates

Veterans who initiated dialysis with a Veterans Health Administration dialysis provider appeared to have lower mortality rates, but experienced increased hospitalization rates compared to veterans who initiated dialysis at non-Veteran Health Administration facilities, according to research appearing in the Clinical Journal of the American Society of Nephrology.

“Given that veterans with ESKD who initiate dialysis under the Veterans Health Administration may have different survival rates according to their dialysis provider at initiation be it a VA dialysis unit or an outsourced dialysis provider such as DaVita or Fresenius or others, we sought to evaluate these important associations,” Elani Streja, MPH, PhD, lead author of the study and director of the transition of care in CKD project in Veterans Administration (VA) Long Beach, told Healio Nephrology.

Streja and colleagues studied 68,727 U.S. veterans who initiated dialysis at either a Veterans Health Administration (VHA) or a non-VHA facility to examine the association of the provider with mortality and hospitalization rates within the first year of initiation.

Researchers found 10% of patients initiated treatment at a VHA dialysis center. These patients were younger, were more likely to be black, had fewer cardiovascular comorbidities and had lower eGFR at initiation; however, they were more likely to be hospitalized within a year.

“Yes, we did find that veteran patients who initiated dialysis treatment in a VA dialysis unit had a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at outsourced units. This could suggest that focused hospitalization to enhance care is beneficial for survival,” said Kamyar Kalantar-Zadeh, MD, study co-author, professor, chief of nephrology at University of California Irvine and principal investigator of the USRDS Special Study Center. “Moreover, since only 10% of all veterans initiate dialysis in one of the 75 VA units given space constraints, an incremental initiation of dialysis at twice-weekly could allow more veterans to start dialysis in the VA system.”

 

Disclosures: Streja is an employee of the Department of Veterans Affairs. Kalantar-Zadeh has received honoraria and/or support from Abbott, AbbVie, Alexion, Amgen, American Society of Nephrology, AstraZeneca, AVEO Oncology, Chugai, DaVita, Fresenius, Genentech, Haymarket Media, Hofstra Medical School, International Federation of Kidney Foundations, International Society of Hemodialysis, International Society of Renal Nutrition and Metabolism, Japanese Society of Dialysis Therapy, Hospira, Kabi, Keryx, Novartis, NIH, National Kidney Foundation, OPKO, Pzer, Relypsa, Resverlogix, Sandoz, Sano, Shire, Vifor, UpToDate, and ZSPharma. Please see the full study for all other authors’ relevant financial disclosures.

Veterans who initiated dialysis with a Veterans Health Administration dialysis provider appeared to have lower mortality rates, but experienced increased hospitalization rates compared to veterans who initiated dialysis at non-Veteran Health Administration facilities, according to research appearing in the Clinical Journal of the American Society of Nephrology.

“Given that veterans with ESKD who initiate dialysis under the Veterans Health Administration may have different survival rates according to their dialysis provider at initiation be it a VA dialysis unit or an outsourced dialysis provider such as DaVita or Fresenius or others, we sought to evaluate these important associations,” Elani Streja, MPH, PhD, lead author of the study and director of the transition of care in CKD project in Veterans Administration (VA) Long Beach, told Healio Nephrology.

Streja and colleagues studied 68,727 U.S. veterans who initiated dialysis at either a Veterans Health Administration (VHA) or a non-VHA facility to examine the association of the provider with mortality and hospitalization rates within the first year of initiation.

Researchers found 10% of patients initiated treatment at a VHA dialysis center. These patients were younger, were more likely to be black, had fewer cardiovascular comorbidities and had lower eGFR at initiation; however, they were more likely to be hospitalized within a year.

“Yes, we did find that veteran patients who initiated dialysis treatment in a VA dialysis unit had a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at outsourced units. This could suggest that focused hospitalization to enhance care is beneficial for survival,” said Kamyar Kalantar-Zadeh, MD, study co-author, professor, chief of nephrology at University of California Irvine and principal investigator of the USRDS Special Study Center. “Moreover, since only 10% of all veterans initiate dialysis in one of the 75 VA units given space constraints, an incremental initiation of dialysis at twice-weekly could allow more veterans to start dialysis in the VA system.”

 

Disclosures: Streja is an employee of the Department of Veterans Affairs. Kalantar-Zadeh has received honoraria and/or support from Abbott, AbbVie, Alexion, Amgen, American Society of Nephrology, AstraZeneca, AVEO Oncology, Chugai, DaVita, Fresenius, Genentech, Haymarket Media, Hofstra Medical School, International Federation of Kidney Foundations, International Society of Hemodialysis, International Society of Renal Nutrition and Metabolism, Japanese Society of Dialysis Therapy, Hospira, Kabi, Keryx, Novartis, NIH, National Kidney Foundation, OPKO, Pzer, Relypsa, Resverlogix, Sandoz, Sano, Shire, Vifor, UpToDate, and ZSPharma. Please see the full study for all other authors’ relevant financial disclosures.

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