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Abstract: FR-PO512

Patient Characteristics Associated With Attrition to In-Center From Home Hemodialysis Treatment

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Blankenship, Derek M., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Chatoth, Dinesh K., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Kraus, Michael A., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
Background

Numerous clinical and practical benefits exist for patients receiving hemodialysis at home (HHD) compared to incenter (ICHD). As important as patients initiating HHD is patients remaining on HHD as benefits persist. The purpose of this study was to assess factors associated with HHD patients who attrition to ICHD.

Methods

This retrospective cohort study identified Fresenius Kidney Care (FKC) patients initiating HHD between Jan. 1st, 2016 and Dec. 31st, 2020. Patients were followed 2 years for time to ICHD transition. A multivariate Cox regression model with baseline characteristics and time updating clinical factors at 3-month intervals assessed ICHD attrition.

Results

3,434 HHD patients were studied of which 361 transitioned to ICHD. Males (Hazard Ratio=1.6, reference=female), single/unknown relationship status (HR=1.5, ref=partnered), uncollected Patient Health Questionnaire-2 (HR=1.3, ref=PHQ-2<3), and Phosphorous >5.5 mg/dL (HR=1.3, ref=5.5 mg/dL or less) were associated with greater likelihood of attrition. Conversely, albumin >4 g/dL (HR=0.7, ref=<3.5 mg/dL) and residual renal urea clearance (KRU) >2 (HR=0.58, ref=0) had a protective association. Race, ethnicity, BMI, dual Medicare/Medicaid, training year, vascular access, diabetes, heart failure, employment, education, dialysis frequency or change, dialysate volume, stan. Kt/V, training sessions, hospitalizations, and blood stream infections were not statically significant.
When adjusting for number of home treatments, an increase in the number of support calls had a protective association as well (HRs=0.67, 0.53, and 0.38 for 1, 2-5, and >5 with ref=0 calls per quarter).

Conclusion

Study identified several clinical and demographic factors associated with HHD patients’ attrition to ICHD. These factors can be used by social workers and clinical staff to identify patients at risk for HHD attrition. Further research should include the creation of a predictive model to optimize the identification of at risk HHD patients. The unsuspected protective association observed for support calls may be an indirect indication of patients’ treatment engagement and should be further investigated as well.

Funding

  • Commercial Support – Fresenius Medical Care