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Kidney Week

Abstract: FR-OR73

Hospitalisation Risk in the Integrated Home Dialysis Model: Analysis of the Canadian Organ Replacement Register

Session Information

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Desbiens, Louis-Charles, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada
  • Tennankore, Karthik K., Dalhousie University, Halifax, Nova Scotia, Canada
  • Goupil, Remi, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Perl, Jeffrey, St Michael's Hospital, Toronto, Ontario, Canada
  • Trinh, Emilie, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
  • Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background

The integrated home dialysis model proposes the initiation of dialysis with peritoneal dialysis (PD) followed by transition to home hemodialysis (HHD) after PD ends. Outcomes of integrated home dialysis versus a “direct to HHD approach” are poorly known. We aimed to compare the hospitalization risk of patients in integrated home dialysis (before, during and after transfer to HHD) with patients directly initiating HHD.

Methods

We studied patients in the Canadian Organ Replacement Register who initiated PD or HHD between 2005 and 2018. A 1:1 propensity score was used to match patients transitioning from PD to HHD in less than 90 days after PD (“PD+HHD” group) to patients with HHD as the first home-dialysis modality (“HHD” group). Our outcome was all-cause hospitalization, assessed from the beginning of home dialysis (PD or HHD) until transfer to facility HD, death, end of follow-up (December 31st 2019) or kidney transplant. Hospitalizations were compared between groups with shared frailty models in three periods: before PD-HHD transition, during transition, and after transition (Fig 1).

Results

From 63,327 patients, 13,726 initiated PD and 745 initiated HHD. 4,420 patients transferred from PD to facility HD and 163 transferred to HHD (3.6% of transfers; median time on PD 1.9 years). Hospitalization risk was similar between groups in the period before and after the PD-HHD transition but was significantly increased during the transition period (Table). Similar trends were observed when these periods were sub-divided by year (Fig 2).

Conclusion

Patients transitioning from PD to HHD do not have an increased hospitalization risk outside their transfer period when compared with patients who start dialysis directly in HHD.

Funding

  • Government Support – Non-U.S.