Abstract: SA-PO925
Associations of Treatment Frequency and Dialysate Volume with Conversion from Home Hemodialysis to Another Dialytic Modality
Session Information
- Dialysis: Home Hemodialysis
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Hemodialysis
Authors
- Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States
- Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States
- Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
- Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
Background
Home hemodialysis (HHD) readily permits increased treatment frequency, which reduces left ventricular mass, blood pressure, and serum phosphorus and improves physical health-related quality of life. However, conversion from HHD to another dialytic modality (e.g., in-center hemodialysis) is common, particularly during the first year of HHD. There is little literature about clinical predictors of conversion. We assessed associations of treatment frequency and dialysate volume with conversion in a contemporary cohort of HHD patients.
Methods
We identified patients who initiated HHD training with the NxStage System One between January 1, 2013, and December 31, 2017, in a large dialysis organization. We retained patients who completed HHD training and were initially prescribed 4-6 sessions/week and ≥90 L/week of dialysate. We followed patients from the first treatment at home until the earliest of conversion to another dialytic modality, death, kidney transplant, or January 31, 2018. We used Cox regression to estimate the hazard of conversion to another dialytic modality, as a dynamic function of treatment frequency and cumulative dialysate volume per week, with adjustment for age, race, sex, body mass index, and vascular access type.
Results
We identified 5545 patients who completed HHD training. Mean age was 54.6 years, 69% of patients were white, 65% were male, and 71% used a fistula. Patients accumulated 6645 patient-years of follow-up. Prescriptions of 4, 5, and 6 sessions/week constituted 28%, 59%, and 14% of follow-up time, respectively, and prescriptions of 90-119, 120-149, 150-179, 180-209, and ≥210 L/week of dialysate constituted 8%, 23%, 34%, 21%, and 14% of follow-up time, respectively. There were 1727 conversions from HHD to another dialytic modality, 685 deaths, and 467 kidney transplants. The adjusted hazard ratio of conversion from HHD to another dialytic modality was 1.06 (95% confidence interval, 0.95-1.18; p = 0.31) for 4 vs. 5 sessions/week and 0.99 (0.85-1.44; p = 0.86) for 6 vs. 5 sessions/week. The corresponding hazard ratio for each 30-L/week increment in dialysate was 1.00 (0.96-1.04; p = 0.96).
Conclusion
Among patients on frequent HHD with low-volume dialysate, neither HD frequency nor dialysate volume per week were associated with conversion to another dialytic modality.
Funding
- Commercial Support – NxStage Medical, Inc.