MEASURING THE ASSOCIATION OF SWITCHING PATIENTS FROM HEMODIALYSIS TO EXPANDED HEMODIALYSIS, WITH HOSPITALIZATIONS, MEDICATION USE, COSTS, AND PATIENT UTILITY

OBJECTIVES : To measure the association between switching patients from high flux hemodialysis (HD) to expanded hemodialysis (HDx) using a medium cut-off off dialyzer with hospitalizations, hospital days, medication use, costs, and patient utilities.

METHODS : The study uses a subset of data collected from the COREXH registry within the Renal Care Services database in Colombia, which captured patients in clinics that had switched all of their patients from HD to HDx after they had been on HD for at least a year. Patients also spent at least a year on treatment with HDx. Hospitalizations, use of medications, and quality of life measured by the KDQoL at the start of HDx, and 1 year after HDx were collected along with demographic characteristics (age, gender, urban, education level, and socioeconomic status), comorbidities, the Karnofsky functional score, and years on dialysis. Univariate and multivariate generalized linear models were run on the outcomes of interest with an indicator for being on HDx.

RESULTS : The study included 81 patients. HDx was significantly associated with lower dosing of several medications including erythropoietin stimulating agents, Iron, hypertension medications and insulin. It was also significantly associated with lower hospital days per year (5.84 on HD versus 4.47 on HDx) though not with number of hospitalizations. HDx was not significantly associated with lower overall costs although the coefficient was sizable and negative. Also, patient utilities were not lower after one year with HDx.

CONCLUSIONS : HDx was associated with reduced hospitalization days and lower doses of medications. While there were not any statistically significant results in terms of costs and utilities, this preliminary analysis was suggestive of potential savings and dominance of HDx via reduced dosing of drugs and reduced hospital days and should motivate future work with larger samples and better controls.