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Abstract: FR-OR71

The Standardized Discontinuation Ratio: A Novel Measure for Real-Time Monitoring of Home Dialysis Discontinuation

Session Information

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Abra, Graham E., Satellite Healthcare, San Jose, California, United States
Background

Home dialysis attrition is a significant challenge. Attrition slows growth, and discourages both nurses and patients who devote great effort to training. Many measures, including the "churn rate" and the cumulative incidence of all-cause attrition, are not ideal for real-time quality monitoring, due to slow evolution and the inclusion of kidney transplantation, a positive outcome. We developed a novel measure, the standardized discontinuation ratio (SDR), that facilitates ongoing assessment of whether the composite event of conversion to in-center hemodialysis or death is occurring more or less frequently than is expected.

Methods

We analyzed the electronic health records of Satellite Healthcare, a mid-sized, not-for-profit dialysis provider. On any given day, we defined the SDR as the ratio of actual versus expected discontinuations from home dialysis during the past 13 weeks. Discontinuation was defined by either conversion from home dialysis to in-center hemodialysis or death. The expected number of discontinuations was summed from patient-day probabilities of discontinuation, estimated as a function of age, modality, and time since home dialysis initiation.

Results

During the 4-year period ending on May 15, 2023, there were 288 discontinuations among 1011 home hemodialysis (HHD) patient-years and 1557 discontinuations among 5430 peritoneal dialysis (PD) patient-years. C-statistics for modality-specific models of discontinuation were 0.61 for HHD and 0.58 for PD. As displayed, the organization-wide SDR from April 2020 to March 2023 varied widely, ranging from 0.77 on July 11, 2020, to 1.34 on March 30, 2021. The SDR was between 1.1 and 1.2 on 12.2% of days during the 3-year period ending in March 2023, and greater than 1.2 on 6.5% of days.

Conclusion

The SDR can be used in real-time to monitor trends in home dialysis discontinuation for the purpose of organizational quality improvement.