New tool may help determine when a patient discontinues home dialysis
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Key takeaways:
- A new tool may help predict when patients may discontinue home dialysis.
- The study was based on patients on home dialysis treated at Satellite Healthcare.
PHILADELPHIA — Researchers presented data here during ASN Kidney Week showing the effectiveness of a standardized discontinuation ratio that can measure when a patient on dialysis may consider discontinuing home therapy.
“Home dialysis attrition is a significant challenge,” Eric D. Weinhandl, PhD, along with Satellite Healthcare colleagues Wael F. Hussein, MD, and Graham E. Abra, MD, wrote in the poster. “Attrition slows growth and discourages both nurses and patients who devote great effort to training. Many measures, including the ‘churn rate’ and the cumulative incidence of all-cause attrition, are not ideal for real-time quality monitoring, due to slow evolution and the inclusion of kidney transplantation, a positive outcome,” Weinhandl and colleagues wrote.
They developed the standardized discontinuation ratio (SDR), a measure that “facilitates ongoing assessment of whether the composite event of conversion to in-center hemodialysis or death is occurring more or less frequently than is expected.”
The researchers reviewed the health records of Satellite Healthcare, a mid-sized, not-for-profit dialysis provider. Weinhandl and colleagues defined the SDR as the ratio of actual vs. expected discontinuations from home dialysis during a 13-week study period. “Discontinuation was defined by either conversion from home dialysis to in-center hemodialysis or death,” they wrote. “The expected number of discontinuations was summed from patient-day probabilities of discontinuation, estimated as a function of age, modality and time since home dialysis initiation.”
During the 4-year study period, ending May 15, 2023, researchers identified 288 discontinuations among 1,011 home hemodialysis patient-years who discontinued dialysis therapy at home. There were1,557 discontinuations among 5,430 peritoneal dialysis patient-years.
“[T]he organization-wide SDR from April 2020 to March 2023 varied widely, ranging from 0.77 on July 11, 2020, to 1.34 on March 30, 2021. The SDR was between 1.1 and 1.2 on 12.2% of days during the 3-year period ending in March 2023, and greater than 1.2 on 6.5% of days,” the researchers wrote.
Weinhandl and colleagues concluded that the SDR “can be used in real-time to monitor trends in home dialysis discontinuation for the purpose of organizational quality improvement.”
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Weinhandl ED, et al. Abstract OR-71. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.
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