Does Early Transition to Home Dialysis Increase Mortality Risk?

A recent registry analysis found a link between early transition to home dialysis and increased risk of death.

Results were reported at the American Society of Nephrology’s Kidney Week 2019, November 5-10, Washington, DC.

It is generally thought that patients starting urgent, unplanned dialysis might prefer home dialysis and have better outcomes with that option, so researchers examined the impact of early transitions from in-center hemodialysis (ICHD) to home dialysis to see whether the practice would decrease the risk of death.

“Few patients who start ICHD urgently and unplanned make an early transition to home dialysis,” wrote researchers led by Sonny Truong Nguyen, MD, Harbor UCLA Medical Center, Torrance, California. “Initiating dialysis in a center with home dialysis may help facilitate these transitions by increased exposure, awareness and education about home dialysis.”

Their analysis included 190 642 adults in the United States Renal Data System who had initiated ICHD with a central venous catheter from 2005 to 2013. Of those patients, 3923 (2%) had transitioned to peritoneal dialysis (PD) and 853 (0.4%) transitioned to home hemodialysis (HHD).
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Transitioning from urgent and unplanned ICHD to HHD within 90 days was associated with a higher mortality risk vs never transitioning, with an adjusted hazard ratio (HR) of 1.31 (95% confidence interval [CI], 1.19-1.44).

By contrast, patients who transitioned to PD within the first 90 days had a lower risk of death vs those who never transitioned (adjusted HR, 0.86; 95% CI, 0.82-0.91).
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Factors associated with making an early transition to HHD included older age, frailty, urban neighborhoods, and starting dialysis in a unit with a HHD program.

Factors associated with early transition to PD included younger age, white race, rural residence, private insurance, and starting dialysis in a unit that had a PD program.

“The different risk factors and demographics of patients transitioning to PD and HHD early suggest that these therapies may attract different types of patients and may explain the differences in outcomes between HHD and PD that we observed,” concluded researchers. “However, further research is needed to understand the higher mortality among early transitions to HHD.”

Reference: Nguyen S, Lidgard B, Chen L, et al. Early transitions from in-center hemodyalisis to home dialysis. Presented at ASN Kidney Week, November 7, 2019. Abstract TH-OR090.