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Kidney Week

Abstract: FR-OR27

Forecasting the Distribution of Dialytic Modalities in the Era of Advancing American Kidney Health

Session Information

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Kubisiak, Kristine, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Weinhandl, Eric D., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Dalrymple, Lorien S., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Kraus, Michael A., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Chatoth, Dinesh K., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Kossmann, Robert J., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
Background

The Executive Order on Advancing American Kidney Health aims to increase home dialysis utilization in patients with end stage kidney disease (ESKD). We constructed a simulation projecting dialytic modality distributions between 2019 and 2030 as a function of changing modality transition rates.

Methods

We specified the US ESKD population in Dec. 2018 and used Markov chain Monte Carlo methods to randomly assign patients to a dialytic modality, transplant, or death each month until Dec. 2030, according to parameters that regulate the inflow and outflow of each state. Incident ESKD patients entered the cohort each month and were subject to the same transition parameters. We assessed how changing transition parameters affects projected dialytic modality distributions.

Results

By prevailing conditions, the simulation projects home dialysis will comprise 12% of the dialysis population in 2025. Increasing home hemodialysis (HD) and peritoneal dialysis (PD) utilization among incident ESKD patients from rates of 0.3% to 7.5% and from 11.5% to 37.5%, respectively, by 2025 results in home dialysis utilization of 25% in 2025 and 29% in 2030. Concurrently increasing the rate of conversion from in-center HD to home dialysis from 3.0 to 15.0 events per 100 patient-years by 2025 results in home dialysis utilization of 37% in 2025 and 44% in 2030, as displayed. Decreasing home dialysis attrition rates has a smaller effect on home dialysis utilization.

Conclusion

Substantial growth of home dialysis utilization in the next decade will require a two-pronged approach to inflow: higher utilization of home dialysis in incident patients, emphasizing PD, and increased conversion of patients from in-center HD to home dialysis.

Funding

  • Commercial Support