Home dialysis can benefit patients who receive urgent in-center hemodialysis

Researchers have studied whether patients who start urgent and unplanned dialysis in clinics experience a survival benefit when they switch to home dialysis.

The results will be presented at ASN Kidney Week 2019 November 5–November 10 at the Walter E. Washington Convention Center in Washington, DC.

Most patients who start urgent and unplanned dialysis receive hemodialysis in clinical centers but might prefer and benefit from home dialysis, which includes peritoneal dialysis (PD) and home hemodialysis (HDD).

Sonny Nguyen, MD (Harbor-UCLA Medical Center) and his colleagues examined information on patients who transitioned from in-center hemodialysis to home dialysis early following an unplanned start of dialysis, and they determined whether those who transitioned early had a lower risk of death.

Of 190,642 patients identified in the United States Renal Data System who initiated urgent in-center hemodialysis from 2005 to 2013, 3923 (2%) transitioned to PD and 853 (0.4%) to HHD, with an average time on PD and HHD of 413 and 224 days, respectively.

Younger age, white race, private insurance, and initiating dialysis in a unit that has a PD program were associated with higher likelihood of an early PD transition.

In contrast, older age, living in the Midwest or South and in wealthier neighborhoods, and initiating dialysis in a unit that has a HHD program was associated with making an early HHD transition.

Those who had transitioned to PD were just as likely to die during the study period as those who had never transitioned to home dialysis; however, those who had transitioned to HHD had a 17% higher risk of death compared with those who had never transitioned to home dialysis.

Few patients who start in-center hemodialysis urgently and unplanned make an early transition to home dialysis. Starting dialysis in a center that also has a home dialysis program may help facilitate these transitions by increased exposure, awareness, and education about home dialysis,"

Dr. Sonny Nguyen

Nguyen continued, "The different risk factors and demographics of patients transitioning to peritoneal dialysis and home hemodialysis early suggest that these therapies may attract different types of patients and may explain the differences in outcomes between peritoneal dialysis and home hemodialysis that we observed; however, further research is needed to understand the higher mortality among early transitions to home hemodialysis."

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