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Kidney Week

Abstract: PO0956

Recent Trends in Utilization of Home Dialysis Modalities, Overall and by Duration of ESKD

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Weinhandl, Eric D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

The Executive Order on Advancing American Kidney Health and the End Stage Renal Disease Treatment Choices payment model have focused attention on increasing utilization of home dialysis. We assessed trends in home dialysis utilization between 2016 and 2021, including variability in trends among strata defined by duration of end stage kidney disease (ESKD).

Methods

We analyzed dialysis facility admission and discharge data extracted from the End Stage Renal Disease Quality Reporting System in May 2021. During the first epidemiologic week of each year from 2016 to 2021, we identified patients undergoing maintenance dialysis at the beginning of the week. For each patient, we identified the current dialytic modality. We estimated trends in utilization of each modality, overall and by duration of ESKD at the beginning of the week (<2, 2-4, 5-9, and ≥10 years).

Results

Between 2016 and 2021, home dialysis utilization increased from 11.5% to 14.3%, with the majority of growth occurring since the beginning of 2019 (figure). Concurrently, HHD utilization increased from 1.57% to 2.23%, whereas PD utilization increased from 10.0% to 12.0%. Among patients with ESKD duration <2 years, home dialysis utilization increased from 14.8% in 2016 to 20.0% in 2021, with >90% of utilization in this stratum due to PD. Among patients with ESKD duration of 2-4 years, home dialysis utilization increased from 11.7% in 2016 to 13.7% in 2021. Among patients with ESKD duration ≥10 years, home dialysis utilization hovered around 9%, although HHD utilization reached a high of 3.65% in 2021, representing nearly 40% of home dialysis utilization in this stratum.

Conclusion

Growth of home dialysis utilization has accelerated since 2019, with greater absolute growth of PD and greater relative growth of HHD. Longer duration of ESKD is associated with lower utilization of PD, but higher utilization of HHD.

Funding

  • NIDDK Support