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Kidney Week

Abstract: TH-OR090

Early Transitions from In-Center Hemodialysis to Home Dialysis

Session Information

  • Home Dialysis
    November 07, 2019 | Location: 143, Walter E. Washington Convention Center
    Abstract Time: 04:54 PM - 05:06 PM

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Nguyen, Sonny Truong, Harbor UCLA Medical Center, Torrance, California, United States
  • Lidgard, Benjamin, Harbor UCLA Medical Center, Torrance, California, United States
  • Chen, Lucia, UCLA, Los Angeles, California, United States
  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
  • Dai, Tiane, Harbor UCLA Medical Center, Torrance, California, United States
  • Saxena, Anjali B., Stanford University / Santa Clara Valley Med Ctr, Los Altos, California, United States
  • Shen, Jenny I., LaBiomed at Harbor-UCLA, Torrance, California, United States
Background

Most patients starting dialysis urgently and unplanned receive in-center hemodialysis (ICHD) but might prefer and have better outcomes on home dialysis. We identified those who transitioned from ICHD to home dialysis early following an unplanned dialysis start and determined whether those who transitioned early had a lower risk of death compared to those remaining on ICHD.

Methods

We identified adults in the USRDS who initiated ICHD from 2005-2013 with a central venous catheter and no maturing arteriovenous access who had no nephrology referral prior to dialysis. We used logistic regression to identify factors associated with an early transition to home dialysis (within 90 days of dialysis initiation). Among those who survived to day 90 of dialysis, we applied a Cox proportional hazards model to find the risk of death for those who transitioned compared to those who did not.

Results

Of 190,642 patients, 3923 (2%) transitioned to peritoneal dialysis (PD) and 853 (0.4%) to home HD (HHD) with an average time on PD and HHD of 413 and 224 days, respectively. Younger age, white race, private insurance, rural neighborhoods, and initiating dialysis in a unit that has a PD program were associated with higher odds of an early PD transition. In contrast, older age, frailty, urban neighborhoods, and initiating dialysis in a unit that has a HHD program was associated with making an early HHD transition. Those who had transitioned to PD at any time during the first 90 days were less likely to die compared to those who had never transitioned to home dialysis [adjusted HR 0.86; 95%CI: 0.82-0.91]. In contrast, transition to HHD in the first 90 days was associated with a higher risk of death compared to those who had never transitioned (adjusted HR 1.31, 95%CI: 1.19-1.44).

Conclusion

Few patients who start ICHD urgently and unplanned make an early transition to home dialysis. Initiating dialysis in a center with home dialysis may help facilitate these transitions by increased exposure, awareness and education about home dialysis. The different risk factors and demographics of patients transitioning to PD and HHD early suggest that these therapies may attract different types of patients and may explain the differences in outcomes between HHD and PD that we observed. However, further research is needed to understand the higher mortality among early transitions to HHD.

Funding

  • NIDDK Support