ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO0957

The Impact of Seasonality on Crash Starts and Home Dialysis Use

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Lin, Eugene, University of Southern California Keck School of Medicine, Los Angeles, California, United States
  • Lung, Khristina I., University of Southern California Leonard D Schaeffer Center for Health Policy and Economics, Los Angeles, California, United States
  • Lakdawalla, Darius, University of Southern California Leonard D Schaeffer Center for Health Policy and Economics, Los Angeles, California, United States
Background

The US has made a concerted effort to increase home dialysis use. Dialysis "crash starts," when patients emergently initiate dialysis in the hospital, are a barrier to home dialysis because they often preclude successful planning. We studied whether the season of the year was associated with crash starts and with home dialysis use among incident patients with end-stage kidney disease (ESKD).

Methods

From the United States Renal Data System, we identified all adults with at least 30 days of continuous Medicare Parts A and B coverage initiating dialysis from 2007-2017. We identified home dialysis use and whether patients were hospitalized within 14 days prior to the first outpatient dialysis treatment (i.e., "crash start"). Using multivariable logistic regression, we studied the association between season, likelihood of crash start, and starting dialysis at home. We used a Cox model to study whether crash starts were associated with ever using home dialysis in the first year. We adjusted for demographics, comorbidities, facility and geographic characteristics, and year of dialysis start.

Results

After adjusting for confounders and year of dialysis start, patients were less likely to start dialysis in the winter versus the summer (OR: 0.86, 95% CI: 0.82, 0.90). Conversely, patients were more likely to "crash start" into dialysis in the winter versus the summer (OR: 1.14, 95% CI: 1.11, 1.17). Patients with a crash start were substantially less likely to initiate with home hemodialysis (OR: 0.16, 95% CI: 0.15, 0.16) and were less likely to ever use home dialysis in the first year (HR: 0.41, 95% CI: 0.40, 0.42). We observed seasonal heterogeneity in the admission diagnoses. Hospitalizations due to pneumonia, myocardial infarction, and congestive heart failure were 1.6, 1.4, and 1.3 times more likely to occur in the winter versus the summer, respectively. Hospitalizations due to diabetes, complications of devices, and chronic kidney disease were 1.05, 1.08, and 1.08 times more likely to occur in the winter, respectively.

Conclusion

We observed more dialysis crash starts in the winter and a subsequent decrease in home dialysis use in the first year. Winter hospitalizations were more often acute and due to cardiac and pulmonary etiologies. Clinicians should remain vigilant that patients may be prone to crash starts in the winter and should accelerate dialysis planning accordingly.

Funding

  • NIDDK Support