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Kidney Week

Abstract: TH-OR092

Training Duration Is Associated with Adverse Events in Home Hemodialysis Patients

Session Information

  • Home Dialysis
    November 07, 2019 | Location: 143, Walter E. Washington Convention Center
    Abstract Time: 05:18 PM - 05:30 PM

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Gionest, Isabelle, Montreal University, Montreal, Quebec, Canada
  • Laurin, Louis-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Lafrance, Jean-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background

Home hemodialysis (HHD) training varies significantly at the center-and patient-levels. This study aimed to explore the clinical outcomes associated with HHD training length.

Methods

All HHD patients successfully trained in a single-center dialysis center between January 2006 and July 2017 were included. Poisson models were built to assess hospitalization rate after start of HHD in the home environment. Potential confounding were defined a priori and included age, sex, diabetes, cause of primary kidney disease and year of HHD start. Time to first adverse event (hospitalization, definitive transfer to in-center hemodialysis [CHD] or death) was evaluated using a Kaplan-Meier curve and log-rank P.

Results

Forty-nine patients graduated from HHD training in our program (1 patient was excluded due to delays related to dialysis machine unavailability). HHD training was offered using a thrice weekly schedule with a median duration of 86 (67-108) days. Mean hospitalization rate was 0.33 (95% CI 0.24-0.44) episode per patient-year. Longer training duration was associated with a trend toward higher hospitalization rates (unadjusted incidence rate ratio [IRR] 1.12 per month, 95% CI 0.99-1.27, p=0.07) and a statistically significant increase in hospitalization rates when adjusted for confounding (adjusted IRR 1.20, 95% CI 1.01-1.41, p=0.03). During the total follow-up time of 131 patient-year, 4 patients died on HHD, 9 were definitively transferred to HD, 18 received a kidney transplantation and 17 patients had a least 1 hospitalization. There was a trend toward lower event-free survival (hospitalization/ definitive transfer to CHD/ death) in the extended training group (≥4 months of training, log-rank p=0.09)

Conclusion

In this small cohort, patients with longer HHD training had more frequent hospitalizations. Enhanced home support could be offered to these more vulnerable patients once they graduate from HHD training.