Abstract: FR-PO0527
Comparative Risk of Vascular-Access Related Infections in Home vs. In-Center Hemodialysis
Session Information
- Home Dialysis: Clinical Epidemiology
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Aragon, Michael A., Outset Medical Inc, San Jose, California, United States
- D'Alessandri-Silva, Cynthia J., Diality, Irvine, California, United States
- Repeck, Kaitlyn, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Young, Eric W., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Perl, Jeffrey, University of Toronto, Toronto, Ontario, Canada
Background
Home hemodialysis (HHD) is increasingly utilized in the U.S. due to its flexibility, cost-effectiveness, and clinical benefits. However, variability in training and ongoing reinforcement and adherence to aseptic technique, vascular access (VA) type, and cannulation method may influence infection risk.
Methods
Adults (≥18 years) with fee-for-service claims in the U.S. Renal Data System (USRDS) from 2016 to 2020 were included. Infection types and events were identified through outpatient and inpatient claims using a 45-day gap rule to group related episodes. Poisson regression was used to calculate incidence rate ratios (IRRs) for infections in HHD vs. ICHD, stratified by VA type and adjusted for age, sex, and cause of kidney failure [TABLE (footnote)].
Results
Compared to ICHD patients, those on HHD were younger (mean age 56.6 vs. 63.5 years), more often male (60% vs. 56%), and less likely to have diabetes as a primary cause of kidney failure (34% vs. 47%). Adjusted infection rates were 1.2–2.3 times higher among HHD patients across all VA types and infection categories. [TABLE]
Conclusion
Infection rates were higher in HHD than in ICHD, according to national USRDS data. These differences may be due to variation in cannulation practices, frequency of access use/cannulation, and adherence to aseptic technique, as well as reduced opportunities for early infection detection and intervention in the home setting. The findings highlight the need for standardized infection prevention protocols, enhanced training and continuous support tailored to the HHD environment.
Funding
- Commercial Support – Outset Medical