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Kidney Week

Abstract: SA-PO656

International Comparison of Home Dialysis Uptake: A Multi-Registry Analysis from the INTEGRATED Research Group

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

  • Boyer, Annabel, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
  • Ethier, Isabelle, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
  • Johnson, David W., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Weinhandl, Eric D., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Tennankore, Karthik K., Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  • Lobbedez, Thierry, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
  • Béchade, Clémence, Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France
  • Elftouh, Naoual, Hopital Maisonneuve-Rosemont Centre de Recherche, Montreal, Quebec, Canada
  • Lambie, Mark, Keele University Faculty of Medicine & Health Sciences, Keele, United Kingdom
  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Group or Team Name

  • INTEGRATED Research Group.
Background

There is a wide variability in home dialysis use from a high of 50% of patients receiving home dialysis in New Zealand to less than 10% in France. We aimed to compare patterns and predictors of home dialysis uptake across different registries.

Methods

This multi-national registry study of home dialysis included data from Australia, New Zealand, Canada, France and USA. Analyses were performed independently in each registry using identical statistical approaches. Multivariable adjusted clustered Cox models were used to evaluate predictors of home dialysis initiation within the first year of kidney replacement therapy (KRT), excluding pre-emptive transplantation.

Results

The proportion of patients starting KRT on home dialysis was 29% in ANZDATA, 22% in CORR, 9.2% in REIN and 8.8% in USRDS. Patterns of transfer from in-center hemodialysis to home dialysis varied between countries, with a marked increase in the proportion of transfer to home dialysis 3 months after KRT start in CORR, ANZDATA and USRDS.After adjustment for patient-related characteristics, patients were most likely to initiate home dialysis within the first month of KRT in all registries. There was a diverging association between sex and home dialysis uptake; females had a lower use of home dialysis in Canada and Australia/New Zealand, and higher use in France and USA.

Conclusion

This study showed marked international differences in the pattern of home dialysis uptake within the first year of KRT. Further work should aim to identify how practice patterns, and governance strategies can mitigate these differences to improve access to home dialysis.

Funding

  • Private Foundation Support