Hospitalization Risk in the Integrated Home Dialysis Model: Analysis of the Canadian Organ Replacement Register.

Area of Science:

• Nephrology
• Dialysis Modalities
• Healthcare Outcomes

Background:

• Integrated home dialysis combines peritoneal dialysis (PD) with a subsequent transition to home hemodialysis (HHD).
• Hospitalization outcomes associated with this integrated model are not well-understood.
• This study compares hospitalization risks in patients transitioning from PD to HHD versus those initiating HHD directly.

Purpose of the Study:

• To compare hospitalization risk before, during, and after a PD-to-HHD transition.
• To compare hospitalization risk in PD-to-HHD transition patients versus incident HHD patients.
• To identify factors influencing hospitalization risk during the transition.

Main Methods:

• Analysis of the Canadian Organ Replacement Register (2005-2018).
• Propensity score matching of 301 patients transitioning from PD to HHD (with <365 days interim hemodialysis) to 711 incident HHD patients.
• All-cause hospitalizations assessed using adjusted negative binomial regression.

Main Results:

• The PD-to-HHD transition group experienced hospitalization rates up to 2.17/patient-year, with infections being the most common cause.
• The PD-to-HHD group had significantly higher hospitalization rates before (IRR 1.38) and during (IRR 2.89) the transition compared to incident HHD patients.
• No significant difference in hospitalization rates was observed after the transition (IRR 1.04).

Conclusions:

• Patients transitioning from PD to HHD face elevated hospitalization risks prior to and during the transfer.
• Hospitalization risk normalizes after patients establish on HHD.
• Shorter durations of interim facility hemodialysis are associated with a less pronounced increase in hospitalization risk.