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Abstract: FR-PO508

Excess Incidence of Home Dialysis Attrition During the COVID-19 Pandemic

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
  • Abra, Graham E., Satellite Healthcare, San Jose, California, United States
  • Schiller, Brigitte, Satellite Healthcare, San Jose, California, United States
Background

Home dialysis utilization in the United States was rapidly increasing before the COVID-19 pandemic. Although patients dialyzing at home during the pandemic had lower risks of COVID-19 hospitalization, relative to patients undergoing in-center hemodialysis (IHD), it is unknown whether attrition—that is, transfer from home dialysis to IHD—was more likely during the pandemic, possibly due to the stress of isolation, as well as the uncertain impact of telehealth in place of in-person visits. We estimated the excess incidence of home dialysis attrition in a small dialysis organization during the pandemic.

Methods

We analyzed home dialysis attrition between March 13, 2020, and March 12, 2022, among patients at Satellite Healthcare. During each month of this interval, we calculated observed and expected numbers of patients who transferred from home dialysis to IHD. The expected number of transfers was derived from a logistic regression model of transfers among all home dialysis patient-days between March 13, 2018, and March 12, 2020, a pre-pandemic interval ending at the declaration of a national emergency. The regression model included time since home dialysis initiation, modality, and age.

Results

The excess incidence of transfer from home hemodialysis (HHD) to IHD was >1.00 between June 2020 and August 2021, but <1.00 thereafter, whereas the excess incidence of transfer from peritoneal dialysis (PD) to IHD was typically between 0.9 and 1.1. Overall, there were 94 transfers from HHD to IHD, compared to 91.5 expected transfers, resulting in excess incidence of 1.03 (95% confidence interval, 0.83-1.24). Meanwhile, there were 518 transfers from PD to IHD, compared to 499.2 expected transfers, resulting in excess incidence of 1.04 (0.95-1.13).

Conclusion

Despite some variability in the excess incidence of home dialysis attrition during first 2 years of the pandemic, attrition from both HHD and PD was in line with pre-pandemic levels.