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Kidney Week

Abstract: SA-PO626

Association of Predialysis Education Choice with Optimal Starts in ESRD

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Park, Ken J., Kaiser Permanente Northwest, Portland, Oregon, United States
  • Tai, Cynthia, Kaiser Permanente Northwest, Portland, Oregon, United States
  • Carl, Daniel E., Kaiser Permanente Northwest, Portland, Oregon, United States
Background

Published studies have shown that choosing home dialysis after modalities education pre-dialysis is associated with higher likelihood of starting on home dialysis (PD or home HD). However, the relationship between patients’ dialysis choice after modalities education and optimal starts (receipt of preemptive kidney transplant, initiation of HD with arteriovenous graft or fistula, or initiation of PD) is unknown. We were interested in whether choosing a home modality was associated with higher likelihood of having an optimal start.

Methods

Our retrospective cohort consisted of 525 patients from Kaiser Permanente Northwest who progressed to ESRD (defined as receipt of preemptive kidney transplant, HD, or PD) from January 1, 2019 to December 31, 2022 and had attended modalities education pre-dialysis. Multiple logistic regression was used to examine the association of patients’ dialysis choice with having an optimal and home dialysis start.

Results

Hemodialysis was chosen by 26% and home dialysis by 54% of patients. Patients were undecided or chose no treatment in 20% of the cohort. Univariate analysis showed that compared to choosing HD or being undecided / choosing no treatment, patients who chose home dialysis were more likely to start optimally (77% vs. 64% vs. 45%, p < 0.005) and to start on home dialysis (55% vs 6% vs. 10%, p < 0.005). After adjusting for race, age, diabetes, and gender, patients choosing home dialysis had 3.8-fold (p < 0.005) and 1.6-fold (p = 0.04) higher odds of starting optimally and a 11.3-fold and 18.3-fold higher odds of starting on home dialysis (p < 0.005) compared to the undecided/no treatment group and hemodialysis group respectively.

Conclusion

Choice of home dialysis after modalities education was associated with a higher likelihood of having an optimal and home dialysis start.