A Comparison of Hospitalization Outcomes Between Peritoneal Dialysis and Home Hemodialysis Patients by Sex and Race

As interest in home dialysis as an initial dialysis modality grows, it remains unclear how the different home dialysis modalities may impact hospitalization outcomes, or how this relationship may change depending on patient sex and race.

We compared all-cause hospitalization rates and days in hospital between incident peritoneal dialysis (PD, n = 14,643) and home hemodialysis (HHD patients, n = 875) between January 2005 and December 2018 (last follow-up was in July 2020) using a nationally representative cohort of incident dialysis patients.

The overall hospitalization rate was 0.82 hospitalization events per patient-year. Compared with those initiated on PD, HHD patients had a lower hospitalization rate (incident rate ratio [IRR] = 0.78, 95% confidence interval [CI] 0.71-0.85), and spent fewer days in hospital (IRR = 0.68, 95% CI: 0.59-0.78). This was more pronounced in more contemporary cohorts and for males. The protective effect of HHD was stronger for Black patients. When hospitalizations were analyzed by cause, the protective effect of HHD was stronger for infection-related admissions, with Black patients seeing the largest benefit.

The type of home modality at dialysis initiation is associated with differences in hospitalization outcomes, an association that is stronger in selected racial groups and sexes. While exploratory in nature, our work highlights the importance of further study on the differential impact of PD and HHD on hospitalization outcomes so that patients incident to dialysis may make an informed decision.