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Abstract: PO0958

Comorbidity Is Not Associated with Home Dialysis Choice

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Vonk, Sanne, University Medical Center Utrecht, Utrecht, Netherlands
  • Bonenkamp, Anna A., Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
  • Vermeeren, Yolande, Department of Internal Medicine, Apeldoorn, Netherlands
  • van Eck van der Sluijs, Anita, University Medical Center Utrecht, Utrecht, Netherlands
  • Hoekstra, Tiny, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
  • Abrahams, Alferso C., University Medical Center Utrecht, Utrecht, Netherlands
  • van Ittersum, Frans J., Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands
  • van Jaarsveld, Brigit C., Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, Netherlands

Group or Team Name

  • DOMESTICO
Background

Over the past 15 years the proportion of Dutch home dialysis patients has decreased markedly. In addition, the rate of home dialysis varies significantly among centers. It is unclear whether this is the result of increased comorbidity, other patient characteristics or because dialysis centers perceive barriers for home dialysis differently. Our aim was to investigate the association between comorbidity and home dialysis.

Methods

The DOMESTICO study is a multicenter retrospective cohort study on home dialysis and randomly selected in-center hemodialysis patients. Comorbidity data was collected of patients who started dialysis between 2012 and 2017, including those who had previously received dialysis or obtained a kidney transplant. Patients who stopped dialysis or died within 30 days were excluded. Comorbidity was assessed with the Charlson comorbidity index (CCI). Home dialysis was defined as any peritoneal dialysis or home hemodialysis treatment during follow-up. Patients were followed until kidney transplantation, wish to stop dialysis, death or study end on 1 January 2017. Multivariable logistic regression analysis was used to assess the association between comorbidity and home dialysis, with a mixed model approach to adjust for dependency of patients within dialysis centers and for other patient characteristics including age, sex, and body mass index (BMI).

Results

Of 1358 included patients, 46% were treated with home dialysis. A high comorbidity score (CCI ≥5) was associated with a lower probability to receive home dialysis compared to patients without comorbidities (unadjusted OR 0.74, 95% CI 0.54–1.00). After adjustments for patient characteristics including age and BMI, there was no association between comorbidity and home dialysis. Only obese patients (BMI ≥30 kg/m2) with comorbidities had a significant lower likelihood to receive home dialysis compared to obese patients without comorbidities (medium comorbidity score (CCI 3-4) adjusted OR 0.40, 95%CI 0.18–0.86 and high comorbidity score (CCI ≥5) adjusted OR 0.43, 95%CI 0.20–0.93).

Conclusion

Comorbidity is not associated with home dialysis, after adjustment for several confounding factors including age and BMI. Future studies should aim at unraveling the center-specific characteristics that play a role in dialysis treatment.

Funding

  • Commercial Support –