Abstract: TH-PO329
Association Between Psychosocial Factors and Receipt of Nocturnal In-Center Hemodialysis Among Prevalent Dialysis Patients
Session Information
- Dialysis: Cost, Socioeconomics, Quality of Life
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Tang, Zhaoli, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Wilk, Adam S., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Hoge, Courtney E., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Plantinga, Laura, Emory University School of Medicine, Atlanta, Georgia, United States
- Lea, Janice P., Emory Dialysis Centers, Atlanta, Georgia, United States
Background
Compared to traditional in-center hemodialysis (HD), nocturnal dialysis (ND) is characterized by longer sessions and nighttime administration, which may lead to better outcomes for some patients. Given the importance of patient choice in the decision to initiate ND, we explored associations between patients’ psychosocial factors and their receipt of ND.
Methods
Among HD patients at a medium-sized dialysis organization, we identified ND patients as those for whom ≥80% of dialysis sessions were ND sessions—starting at 6:30 pm or later and lasting ≥5 hours—over the 3 months (≥20 sessions total) after their first ND session. We extracted dialysis session data from electronic medical records and psychosocial data from social worker assessments typically performed at dialysis start. We performed descriptive analyses of ND and non-ND patients among all HD patients. We also analyzed the subsample of patients whose available psychosocial assessment data were more timely: i.e., patients whose psychosocial assessment was conducted between 1 year before and 1 month after their first ND session (for ND patients) or within the first year of dialysis at the dialysis organization (for non-ND patients). We tested associations of psychosocial factors with ND receipt in logistic regression models.
Results
We identified 64 ND patients in the total sample (5.5% of 1,169 HD patients). ND versus non-ND patients had greater full or part-time employment (26.8% vs. 8.5%, p<0.01), were less likely to require ambulatory assistance (14.1% vs. 41.2%, p<0.01), and were more likely to live alone (33.3% vs. 19.3%, p<0.01). Factors not associated with ND status included being married (26.7% vs. 30.9%, p=0.49) and having daily access to support at home (70.0% vs. 71.6%, p=0.79). For the subsample of 25 ND patients with timely psychosocial data (3.2% of 792 subsample HD patients), the relationships between ND and psychosocial characteristics were similar. Regression results were also qualitatively similar for both samples.
Conclusion
Patient psychosocial characteristics strongly predict receipt of ND care. It may be important to account for differences in psychosocial factors, which are typically unmeasured, when comparing outcomes for ND and non-ND patients.