Outcomes of Patients with Nonkidney Medical Therapies Dialyzed at Chronic Hemodialysis Centers

Background: Patients (pts) with non-renal medical therapies (NRMT) such as wearable defibrillators, tracheostomies, continuous cardiac infusions, or left ventricular assist devices (LVAD) may face challenges when seeking dialysis outside of a nursing facility with in-house dialysis or a hospital setting. Fresenius Kidney Care has established policies and a developed process in which requests for dialysis are reviewed by a team of nurses and physicians with collaboration of the dialysis facility. The current analysis aims to determine outcomes of these pts in a chronic hemodialysis unit. Methods: As part of a quality initiative, we retrospectively assessed time before discharge (due to any reason including renal recovery, transplant, and death) by period (1, 3, 6, and 12 months) for all pts starting treatment 1/22-12/23. At each comparison, only those pts who were eligible for that length of follow-up are included. For the overall analysis, each person is included only once. In the NRMT analysis, a person with multiple NRMT would appear in multiple columns. A group with <5 people (artificial total heart) was not included in the NRMT analysis. Results: Time on dialysis (no discharge), overall and by NRMT grouping, is shown in table 1. Overall, 87%, 72%, 58%, and 45% of pts were dialyzed at least 1, 3, 6, and 12 months, respectively. There were 0.50 deaths/patient year (py), 0.14 renal recoveries/py, and 0.01 transplants/py. 22% were dialysis dependent AKI and 78% ESKD. Pts with WD were the largest NRMT group, and they had 45% of pts on dialysis at 12 months. In this subgroup, there were 0.48 deaths/patient year (py), 0.13 renal recoveries/py, and 0.01 transplants/py. Conclusion: Our results show that appropriate pts with destination therapies, NRMT, can be safely cared for at the destination of their choice and do not require life-long institution. Survival, renal recovery and even transplant can be obtained with the assistance of dialysis provided in-center. Funding: Commercial Support - Fresenius Medical Care