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Home Dialysis Transitions in Canada During the COVID-19 Pandemic: An Interrupted Time Series Analysis

Davide Verrelli1, Reid Whitlock2, Thomas Ferguson2

  • 1Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.

Kidney Medicine
|February 2, 2026
PubMed

Insights

During the COVID-19 pandemic, transitions to home dialysis increased in Canada, aligning with recommendations to reduce infection risks. However, transfers from home dialysis back to facility-based care also rose, with unclear reasons.

Area of Science:

  • Nephrology
  • Public Health
  • Epidemiology

Background:

  • The COVID-19 pandemic prompted recommendations for shifting from facility-based hemodialysis to home dialysis to mitigate infection risks.
  • Understanding changes in dialysis modality transitions during the pandemic is crucial for patient care and resource allocation.

Purpose of the Study:

  • To compare the rates and reasons for transitions from facility-based hemodialysis to home dialysis before and during the COVID-19 pandemic in Canada.
  • To assess the rates and reasons for transfers from home dialysis back to facility-based hemodialysis during the same periods.

Main Methods:

  • An interrupted time-series analysis was conducted using administrative data from the Canadian Organ Replacement Register.
  • The study included adults receiving hemodialysis, comparing data from the prepandemic period (January 2016-December 2019) with the early pandemic period (April 2020-September 2021).
  • Segmented linear regression and analysis of covariance were used to analyze monthly transition rates and transfer reasons.

Main Results:

  • Transitions to home dialysis increased significantly during the early pandemic (0.60 per 10,000 patients/month, P=0.03).
  • Monthly transfers from home dialysis to facility-based hemodialysis also increased significantly during the pandemic (6.91 per 10,000 patients, P<0.001).
  • Geographic or resource-related reasons accounted for a higher proportion of home-to-facility transfers during the pandemic (5.8% vs 2.7%, P<0.0001).

Conclusions:

  • Canadian kidney care programs appear to have increased transitions to home dialysis in response to COVID-19 pandemic recommendations.
  • The reasons behind the increased rate of transfers from home dialysis back to facility-based care during the pandemic remain unclear and warrant further investigation.
Abstract

Keywords:
COVID-19 pandemicdialysis transitionshemodialysishome dialysisinterrupted time seriesperitoneal dialysis

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