Understanding Patient Centre and Dialysis Characteristics Variance among Patients on Dialysis in Public Private Partnership Centres

BACKGROUND: Payer characteristics is rapidly changing for dialysis in India. Public partnership is a an evolving model with its set unique challenges for patients and providers. An understanding of variance will help address the gaps in the health system AIM OF THE STUDY: 1. To compare difference in patient center and dialysis characteristics between PPP and non-PPP centers 2. To assess gaps in health system for planning and improvement METHODS: 797 Non-COVID deaths that occurred in large dialysis network between Jan and Mar 2021 were compared to age matched controls to study factors influencing mortality: gender educational status BMI duration of HD center size for staff and patient numbers payer type HD frequency access Hb S. Albumin diabetic status Htn h/o heart failure and h/o hospitalization. A multivariate analysis identified factors influencing mortality. In a sub-analysis of this study, we compared characteristics across centers under public-private partnership (PPP) and non-PPP of above characteristics and learn salient differences. RESULT(S): a. Comparison of patient, center, HD characteristics (mean + sd) PPP (n = 715). Non-PPP (n = 869). p value Age (yrs) 52 + 12.7 56.9 + 13.8 < .001 Height (cm) 160 + 9.5 161.7 + 9 < . 001 Weight (Kg) 57.7 + 11.7 59 + 12.4 .02 BMI 22.5 + 4.3 22.6 + 4.8 .63 Distance (km) 30. 8 + 34.8 30.7 + 10 <.001 No of staff 22.1 + 23.4 18.3 + 15.5 <.001 No of patients 22.1 + 21.3 15.7 + 11.3 <.001 HD (Months) 16.8 + 16.8 18.2 + 18.2 .08 HB (g%) 8.5 + 1.5 9.1 + 1.6 <.001 Adequacy 1.2 + .1 1.3 + .2 .003 Alb (g%) 3.5 + .7 3.5 + .5 . 17 b. Comparison of proportions of patient characteristics (as %) PPP Non-PPP p value Non-survivor: Survivor 59.6/40.4 41.4/58.5 <.001 Perm/Tem 75.9/24.1 75/25 .67 Gender M 74.7/25.3 68.1/31.9 .04 Educ: < College/College 89.4/10.6 69.7/30.3 <.001 HD frequency < /> 2x 51.8/49.8 66.3/31.1 <.001 Diab: Non-diabetic 24.9/75.1 44.8/552 <.001 Heart failure: Y/N 6.7/93.3 10.9/89.1 .004 Hospitalization: Y/N 16.1/83.9 31.1/68.9 <.001 CONCLUSION(S): Patients in PPP centers are younger and more likely to be men and shorter in height, less educated. They are more anemic, dialyzed thrice with lesser proportion who have diabetes and heart failure. Centers are less accessible and larger in size. Understanding these differences will help health systems direct more customized patient-centric interventions to improve outcome.

Characteristics and outcome of AKI needing dialysis with COVID-19 infection

Background: COVID-19 infection has varying grades of mortality worldwide. Multi-organ injury, not uncommonly associated with AKI, portends a poor outcome. We studied AKI needing hemodialysis (HD) in the context of COVID-19 infection Methods: From March 15th to May 25th 2020, for consecutive COVID-19 infections AKI needing HD in a large dialysis network age, gender, payer type, days:admission to HD start, urine output, S. Cr, comorbidities, other organ injuries, length of stay & outcome, dialysis session details: blood flow rate(BFR), dialysis flow rate(DFR), ultafiltration volume were reviewed. We compared survivors and non survivors using Mann Whitney/ Wilcoxon 2 sample test for medians and Fisher exact 2 tailed for association Results: n = 20. Mean age: 56. 7 + 3.93 years. M:F 17:3, 9 survived, 11 expired. HD sessions=51;CRRT: 4, duration: 29.2 ± 25.4 hours. 47 sessions: Duration: 4.87 ± 1.11 hours, BFR: 195 ± 43 ml/min, DFR: 389 ±99 ml/mn, UF: 437ml/hour. No clotting reported. Conclusions: AKI needing HD in COVID-19 infection is associated with significant multiorgan injury and high mortality;middle aged male predominate. No significant clinical characteristics were predictive of survival in a sample size.

CKD patients on hemodialysis (HD) with COVID-19 infection: Characteristics and outcome

Background: The COVID-19 pandemic has special significance for Chronic Kidney Disease patients on HD. Clinical characteristics and outcome from low resource settings are not well known Methods: From March 15 2020 until May 20, 2020, quality managers reviewed all patients with confirmed COVID-19 infections in 200 HD centres among MHD patients. For patients with COVID-19 infections: age, gender, geographical zone, type of Insurance, continuity of care was noted, HD characteristics and outcome were reviewed. Comparison of median was done with Mann Whitney/Wilcoxon 2 sample test and proportion with Fisther exact test. All patients were transferred to public hospital for regulatory compliance limiting follow up of HD sessions. Results: 39 out of 18402 patients developed COVID-19 infection. M: F: 28: 11, Age;54.62 + 14.92 years. Geographically: East zone:3(7%), North:12(31%), South:5(12%), West:19(50%). Payers: self pay:19(49%), government insurance:15 (38%) and private Insurance:5(13%). 32(82%) hypertensives, 23(59%)diabetics. Outcome: 8(20%) expired, 18(46%) discharged, 12(31%) in hospital and 1 at home. Mean Hb (77%) : 9.81 ±1.71 g%, Adequacy (74%): 1.30 ± .44, Vascular access (72%): 75% permanent access, 7% temporary catheter, 18% tunneled catheter, Albumin (64%): 3.69 ±.31. Conclusions: Maintenance HD patients have increased mortality as compared to reports in normal population and is associated with need for intensive care, steroid use and ventilatory support.