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Kidney Week

Abstract: FR-OR28

Hospitalization and Day of the Week: Comparing Peritoneal Dialysis, Home Hemodialysis, and In-Center Hemodialysis

Session Information

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Tennankore, Karthik K., Dalhousie University, Halifax, Nova Scotia, Canada
  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Matheson, Kara, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
  • Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
  • Trinh, Emilie, McGill University, Montreal, Quebec, Canada
  • Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
Background

Studies have shown that there are daily variations in mortality for patients receiving in-center hemodialysis (HD) but not home HD, peritoneal dialysis or more frequent in-center HD. Less is known about daily variations in hospitalization according to dialysis modality.

Methods

We analyzed all chronic dialysis patients in Canada (excluding Manitoba and Quebec) from 1 Jan 2005 to 31 Dec 2014 using the Canadian Organ Replacement Register (CORR). Dialysis modalities were defined (using CORR) as peritoneal dialysis, conventional HD or frequent HD (nocturnal or short daily) and HD modalities were furthered categorized as home versus in-center. All switches between modalities after dialysis initiation were included provided the duration of the switch was >30 days. The absolute number of hospitalizations for each day of the week was reported for each treatment type and differences in the distribution of hospitalizations were compared using the Chi-Square test.

Results

The cohort consisted of 36,334 individuals. Median age was 67 and 61% were of male sex. A total of 81% of patients were receiving hemodialysis at dialysis initiation and the cause of end-stage kidney disease was secondary to diabetes in 37%. Overall, there were 119,466 hospitalizations over the observation period. The cumulative number of hospitalizations was highest for conventional in-center HD (92,707) and lowest for conventional home HD (701). Day of the week admissions for each treatment type are noted in Table 1 (P<0.001). Hospitalizations were least frequent on saturday and sunday for all groups. The proportion of admissions was highest on monday or tuesday for conventional HD (regardless of location) and frequent in-center HD. In contrast, frequent home HD had a higher proportion of admissions on wednesday.

Conclusion

There are daily variations in hospitalization comparing dialysis modalities. Future planned analyses will evalute whether there are adjusted differences in day of the week hospitalization across modalities accounting for differences in patient characteristics.

Day of the week hospitalization for each dialysis treatment type (N, %)