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Prevalence-Based Targets Underestimate Home Dialysis Program Activity and Requirements for Growth
Micheli U Bevilacqua1,2, Lee Er2, Michael A Copland3
1University of British Columbia, Vancouver, BC, Canada mike.bevilacqua@bcpra.ca.
Summary
Home dialysis prevalence metrics may not fully capture program activity due to high patient turnover, including transplantation. Understanding patient trajectories is crucial for accurate assessment of home dialysis program growth.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Dialysis Modalities
Background:
- Many renal programs aim to increase home dialysis prevalence.
- This study investigates if prevalence accurately reflects program activity and growth efforts.
Purpose of the Study:
- To evaluate the accuracy of home dialysis prevalence as a metric for program activity.
- To assess if prevalence-based metrics adequately reflect the work involved in home dialysis program expansion.
Main Methods:
- Analysis of data from Canadian home dialysis programs (2005-2015).
- Comparison of prevalence data with dialysis activity (intakes, exits).
- Calculation of recruitment rates needed for prevalence targets.
Main Results:
- Home dialysis proportion increased from 29.3% to 32.6% over ten years.
- High patient turnover observed, with 13.6 new patients recruited for every net growth.
- Home dialysis patients had higher transplantation rates than facility-based hemodialysis.
Conclusions:
- Home dialysis prevalence is an incomplete marker of total program activity due to significant patient turnover.
- High transplantation rates, while desirable, impact prevalence metrics.
- Renal programs need to consider these metric shortcomings and better understand home dialysis patient complexities.
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