Abstract: FR-PO0566
Associations of Comorbid Conditions with Outcomes in Patients Initiating Home Dialysis
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
- Weinhandl, Eric D., DaVita Inc, Denver, Colorado, United States
- Shapiro, Mark H., DaVita Inc, Denver, Colorado, United States
- del Rosario, Maria B., DaVita Inc, Denver, Colorado, United States
- Cassin, Michelle, DaVita Inc, Denver, Colorado, United States
- Naljayan, Mihran V., DaVita Inc, Denver, Colorado, United States
Background
Ongoing growth of home dialysis depends on not only the number of patients who initiate either peritoneal dialysis (PD) or home hemodialysis (HHD), but also the rate at which patients discontinue home dialysis. The prescription of home dialysis to patients with more severe comorbidities may limit impact overall utilization due to higher rates of discontinuation. The purpose of this study was to understand the prevalence of specific comorbid conditions and their associations with clinical outcomes in patients initiating home dialysis.
Methods
From United States Renal Data System Standard Analysis Files with data through 2021, we identified (1) incident end-stage kidney disease (ESKD) patients who initiated PD in 2011-2019 and (2) prevalent ESKD patients who initiated HHD in 2011-2019. For each modality, we estimated associations of five common comorbid conditions [diabetes mellitus (DM), heart failure (HF), atrial fibrillation (AF), ischemic heart disease, and chronic obstructive pulmonary disease (COPD)] with three outcomes [death, modality change (i.e., conversion to in-center hemodialysis), and kidney transplant]. Associations were derived from Cox regression models adjusted for age, sex, race, Hispanic ethnicity, ESKD network, and primary cause of and duration of ESKD.
Results
The cohort included 145,862 PD and 32,202 HHD patients. The prevalence of DM exceeded 50% in both modalities; HF was also common. For both modalities, DM, HF, and COPD were consistently associated with higher adjusted rates of death and (to a lesser extent) modality change and lower adjusted rates of kidney transplant. For both modalities, the number of comorbid conditions among DM, HF, and COPD (0, 1, 2, or 3) was associated with outcome rates in a graded manner.
Conclusion
Among patients initiating home dialysis, the presence of several comorbid conditions individually or in combination increases the rates of death and modality change, and lower rates of kidney transplant. Future studies identifying and utilizing additional strategies to manage comorbidities in patients on home therapies may have a beneficial clinical impact.