Kidney Week

Abstract: FR-PO1063

Characteristics of Patients on Home Hemodialysis (HHD) and Barriers for HHD Program Expansion in Patients Living in Neighborhoods with Socioeconomic Disadvantage

Session Information

• Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Al-Dmour, Mohammad H., Harbor-UCLA Medical Center, Torrance, California, United States

Mohammad H. Al-Dmour, MD

• Shen, Jenny I., Harbor-UCLA Medical Center, Torrance, California, United States

Jenny I. Shen, MD, MS, FASN

• Shah, Anuja P., Harbor-UCLA Medical Center, Torrance, California, United States

Anuja P. Shah, MD

• Dukkipati, Ramanath B., Harbor-UCLA Medical Center, Torrance, California, United States

Ramanath B. Dukkipati, MD

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Dai, Tiane, Harbor-UCLA Medical Center, Torrance, California, United States

Tiane Dai, MD, PhD

Background

Home hemodialysis (HHD) remains underutilized despite increasing emphasis on home-based kidney replacement therapies. The IM-HOME study identified barriers to home dialysis including fear of treatment, limited home space, inadequate support, and insufficient education. We evaluated characteristics and outcomes of patients enrolled in an HHD program serving socioeconomically disadvantaged communities.

Methods

We conducted a single-center retrospective study over 7 years including 38 patients enrolled in an HHD training program. Demographics, cause of end-stage kidney disease (ESKD), prior dialysis modality, insurance status, care partner availability, and outcomes were analyzed descriptively.

Results

Among 38 patients enrolled in HHD training, 27 (71%) completed training and 11 (29%) dropped out. Median age was 52 years, and mean age was 49 years. Most patients were 45–64 years old (55%), while 34% were 18–44 years old. The cohort was predominantly male (82%). The population was racially and ethnically diverse: Hispanic 37%, Black 34%, White 16%, and Asian 13%. Hypertension (37%) and diabetes (32%) were the causes of ESKD. Most patients transitioned from in-center hemodialysis (ICHD) (79%); 16% initiated dialysis directly with HHD and 5% transitioned from peritoneal dialysis (PD). Insurance coverage included MediCal alone in 47% and MediCal/Medicare in 37%. A care partner was available in 55% of patients. Patients completing HHD training were older (median age 54 vs. 48 years) and more likely to be male (89% vs. 64%) than dropouts. Female patients represented a larger proportion of dropouts (36% vs. 11%). Black patients accounted for a greater proportion of dropouts (45% vs. 30%), whereas Hispanic patients were more likely to complete training (41% vs. 27%). At follow-up, 14 patients (37%) remained active on HHD, 6 (16%) transferred to ICHD, 2 (5%) underwent transplantation, and 5 (13%) died while on HHD.

Conclusion

Most patients successfully completed HHD training despite socioeconomic disadvantage. Compared with national HHD populations, this cohort demonstrated greater racial and ethnic diversity. Female sex and Black race were associated with higher training dropout, suggesting persistent disparities in HHD retention. Limited support and socioeconomic barriers may contribute to reduced HHD sustainability in underserved populations.

Funding

• Private Foundation Support