Abstract: SA-PO1075
Profiles of Demographics, Nutrition, and Outcomes in Home and In-Center Hemodialysis
Session Information
- Home Hemodialysis
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Hemodialysis
Authors
- Danziger, John, Harvard Medical School, Brookline, Massachusetts, United States
- Chaudhuri, Sheetal, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Willetts, Joanna, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Turk, Joseph E., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Hymes, Jeffrey L., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Kossmann, Robert J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
Background
Home hemodialysis (HHD) may have favorable attributes related to the provision of better adequacy and fluid removal with more frequent treatments. HHD has been associated with improved blood pressure control and lower all-cause/cardiovascular event rates. We characterized the demographics, nutritional status, and outcomes among patients undergoing HHD and in-center hemodialysis (ICHD) at a large dialysis organization (LDO).
Methods
We used data from HHD and ICHD patients treated at the LDO in November 2018 to January 2019. We profiled the average proportion of HHD and ICHD patients achieving target goals for i) albumin ≥4mg/dL, ii) mineral bone disorder (MBD) with calcium ≤10.0mg/dL, phosphate ≥3.0-≤5.5mg/dL, and intact parathyroid hormone (iPTH) ≥150-≤600pg/mL, and iii) central venous catheter (CVC) <90 days. We also calculated the unadjusted hospital admission rates per patient per year (ppy) for the groups.
Results
We included data on 171,712 patients (HHD n=4141, ICHD n=167571). A larger proportion of HHD patients were younger (HHD=55.5, ICHD=63.5 years), male (HHD=63%, ICHD=57%), and white race (HHD=55%, ICHD=47%). A greater proportion of HHD patients achieved target albumin levels (HHD=51%, ICHD=37%), yet a slightly lower proportion of HHD patients achieved MBD goals (HHD=46%, ICHD=49%). The proportion of patients with catheter exposure >90 days was relatively consistent between groups (HHD=13%, ICHD=15%). Patients treated with HHD exhibited lower hospital admission rates (HHD=1.07, ICHD=1.55 admits ppy).
Conclusion
Patients treated with HHD more commonly achieved nutritional goals for albumin compared to those treated with ICHD. HHD patients may have unique eating habits with more protein and dietary phosphate intake that may be leading to lower MBD goal achievement compared to ICHD. HHD patients tended to have less hospital admissions compared to ICHD, yet an adjusted analysis is needed to validate this observation in a population group with distinct demographics.
Funding
- Commercial Support – Fresenius Medical Care North America