Trends in Procedures to Initiate Renal Replacement Therapy Among People Living with Spina Bifida

PURPOSE Given the increasing prevalence of chronic kidney disease in people with spina bifida, we sought to determine if this is associated with an increase in end stage kidney disease. We examined population-based data to measure the frequency of procedures to establish renal replacement therapy-a marker for end stage kidney disease-among patients with spina bifida. MATERIALS AND METHODS We used the State Inpatient Database and State Ambulatory Surgery and Services Databases from Florida, Kentucky, Maryland, and New York (2000 to 2014), which include encounter-level data. With a diagnosis code-based algorithm we identified all procedural encounters made by patients with spina bifida. We determined the percentage of these encounters that were for facilitating renal replacement therapy (i.e., arteriovenous anastomosis, renal transplantation). We assessed for changes over time in this percentage with the Cochran-Armitage trend test. Bivariate analysis was performed using Chi square test. RESULTS Of all procedures performed on patients with spina bifida over this time, the proportion of procedures performed to establish renal replacement therapy significantly decreased in both the inpatient and outpatient setting (p=0.042 and p<0.001, respectively). People with spina bifida undergoing procedures to establish renal replacement therapy were, on average, young adults (mean 34.5 and 36.0 years) with a high prevalence hypertension (75.8% of inpatients, 68.6% of outpatients). CONCLUSIONS The frequency of surgeries to initiate renal replacement therapy among people with spina bifida undergoing procedures is low and is not increasing. This highlights the importance of consistent care throughout adolescence and young adulthood and hypertension screening.