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Kidney Week

Abstract: PO1241

Home Hemodialysis Patient Loss: A Quality Improvement Initiative to Review Technique Failure in Alberta Kidney Care - South

Session Information

  • Home Hemodialysis
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Paterson, Bailey, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Riehl-Tonn, Victoria, Mount Royal University, Calgary, Alberta, Canada
  • Qirjazi, Elena, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • MacRae, Jennifer M., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background

The number of dialysis patients has increased 15% over 5 years in Alberta Kidney Care South (AKC-S) with most patients pursuing in-centre hemodialysis. Although home hemodialysis (HHD) offers advantages of improved quality of life for patients and cost savings for programs it has grown at a slower rate. To increase the number of HHD patients, programs need to promote more patients to start on HHD and reduce the number of patients leaving HHD. Understanding the reasons for exit from HHD may lead to strategies to reduce patient loss.

Methods

A retrospective cohort study of adult HHD patients who entered training for HHD between January 1 2013 to December 31 2018 in AKC-S, followed until exit/study end date. Reasons for technique failure (TF) identified, with KM estimates used to determine technique survival, and Cox proportional hazard model used to determine risk factors for TF.

Results

147 patients entered the HHD program-48(33%) women; 44(30%) DM, 38(25.9%) CAD, 14(9.5%) CVD, mean age of 54(13) years. 12(8.1%) did not complete training. Overall time in program 28 +/- 20 months, average training time 6.7 +/- 3.3 weeks. Reasons for exit include transplant 24(48%), death 6(4.5%), TF 32(24%). TF reasons include medical 9(39.1%), psychiatric 2(8.7%), social 3(13.0%), safety 4(17.4%), patient request 4(17.45%), change to PD 1(4.3%). Technique survival at 1, 2, and 5 years 91%, 85%, and 63%. Risk factors for TF include DM 2.36(1.06, 5.28) p= 0.036, CVD 4.34(1.8, 10.5) p=0.001 and a longer training time 1.18(1.07, 1.30) p=0.001.

Conclusion

We found a high HHD turnover rate with technique survival rates decreasing with time. Risk factors for TF include patients with DM, CVD, longer training time. Improved identification of and education for potential HHD patients could reduce training failure rates. Interventions to provide better support for patients at risk of TF could help keep patients at home longer.

Figure 1. Cumulative Incidence of Competing Risks.