Longitudinal Assessment of Clinical Outcomes for Transitional Care Units

Background: Transitional Care Units (TCUs) are designed to enhance patient support at time of dialysis initiation and provide comprehensive education on renal replacement therapies. We previously published a Propensity Score Matched (PSM) study and reported dialysis patients attending a TCU had higher rates of transplant referral (TR) and preferred modality compared to controls and no difference in mortality and hospitalizations (Blankenship 2022). The purpose of this project was to further understand the potential impact of TCUs throughout the follow-up of the original study. Specifically, TR, modality, mortality, and hospitalizations were assessed for their consistency and timing of results over the 2-year study period. Methods: The study identified Fresenius Kidney Care (FKC) patients new to dialysis and starting incenter hemodialysis (ICHD) within a TCU between Oct. 1st, 2019 and Sept. 30th, 2020 with a follow-up through Oct. 1st, 2021. This 2-year study period was divided into 8 quarters consisting of the patients and outcome information available at each look. PSM and statistical methods were performed as in the published analysis at each time point. Results: Modality and TR were consistently significant after 6 months and throughout the remainder of the study. At 6 months, 19% of TCU patients chose a home modality as compared to 4% of controls, and 52% of TCU patients were at least referred for transplantation as compared to 36% of controls. Hospitalization was not statistically significant after correcting for multiple tests. Interestingly, mortality trended positive and was statistically significant after 1 year. At a time corresponding with an initial wave of COVID-19, mortality was no longer statistically significant at 15 months, but trended positive thereafter. Conclusion: This study found the positive association of TCUs with chosen modality and TR was relatively early at 6 months and consistent thereafter. Although mortality was not statistically significant in the original analysis, the longitudinal analysis determined TCU patients had favorable mortality outcomes after 1 year (HR=0.16) which were negated during the first year of COVID-19 pandemic. This finding warrants further investigation and follow-up. Funding: Commercial Support-Fresenius Medical Care Funding: Commercial Support - Fresenius Medical Care