Uptake of home dialysis by patients in first year varies by country
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Key takeaways:
- A review of international registries shows patients who choose home in the first year of dialysis treatment varies by country.
- Australia had the highest percentage of patients who chose home dialysis.
PHILADELPHIA — The percent of patients who choose home dialysis within the first year of treatment varies by country, a study presented here showed.
“There is a wide variability in home dialysis use from a high of 50% of patients receiving home dialysis in New Zealand to less than 10% in France,” Annabel Boyer, MD, of the Centre Hospitalier Universitaire de Caen, Caen, Basse-Normandie, France, and colleagues from Canada, Australia, the United States and the United Kingdom wrote in the poster. “We aimed to compare patterns and predictors of home dialysis uptake across different registries.”
The multi-registry analysis from the Integrated Research Group included data from Australia, New Zealand, Canada, France and the United States. Each registry conducted independent data review using identical statistical approaches. “Multivariable adjusted clustered Cox models were used to evaluate predictors of home dialysis initiation within the first year of kidney replacement therapy (KRT), excluding preemptive transplantation,” the authors wrote.
Based on data analysis from each registry, the researchers concluded that the proportion of patients starting KRT on home dialysis was highest in Australia (Australia and New Zealand Dialysis and Transplant Registry [ANZDATA]) at 29%. The second highest first-year starts on home therapy occurred in Canada (22%; Canadian Organ Replacement Registry [CORR]), followed by 9.2% in France (Renal Epidemiology and Information Network [REIN]) and 8.8% in the United States (U.S. Renal Data System [USRDS]).
“Patterns of transfer from in-center hemodialysis to home dialysis varied between countries, with a marked increase in the proportion of transfer to home dialysis 3 months after KRT start in CORR, ANZDATA and USRDS [databases],” the authors wrote. “After adjustment for patient-related characteristics, patients were most likely to initiate home dialysis within the first month of KRT in all registries.”
Researchers noted a diverging association between sex and home dialysis uptake in their data analyses. Women had a lower use of home dialysis in Canada and Australia/New Zealand. They had a higher use in France and the United States.
“This study showed marked international differences in the pattern of home dialysis uptake within the first year of KRT,” Boyer and the authors wrote. “Further work should aim to identify how practice patterns and governance strategies can mitigate these differences to improve access to home dialysis.”
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Boyer A, et al. Abstract SA-PO656. Presented at: ASN Kidney Week; Nov. 2-5, 2023; Philadelphia.
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