Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis

Abstract

Background Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. Methods The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. Results Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. Conclusion Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.

Early Referral to Nephrological Care and the Uptake of Peritoneal Dialysis. An Analysis of German Claims Data

“…In the literature, ER was operationalized as care by a nephrological specialist between one month and one year before a patient's first dialysis [8,11,[14][15][16][17][18]. Hence, patients who had their first encounter with a nephrologist within six months (≤180 days) before their first dialysis were classified as LR, and those whose first encounter exceeded six months were classified as ER.…”

“…The operationalization of ER in the literature varied between one month and one year [8,11,[14][15][16][17][18]. The different definitions discussed in a review [16] considered the time for medical preparation as a reason for the narrow definition of 3-4 months.…”

“…LR to a nephrological specialist is often seen as a barrier to PD [13]. The literature shows that CKD patients with ER to nephrological care are more likely to conduct PD [11,[14][15][16][17][18]. A pooled analysis of a systematic Cochrane review reported patients with ER were twice as likely to choose PD [8].…”

Assisted peritoneal dialysis across Europe: Practice variation and factors associated with availability

“…6,11,19,31,32 This variation may be due to differences in clinical background and experience of healthcare professionals, centre characteristics, organisational and financial factors, as shown in studies regarding PD in general. 6,[33][34][35][36][37] However, this has not been specifically investigated for assisted PD so far.…”

Early results and medico-economic evaluation of a short daily home hemodialysis program in a Private hemodialysis center

“…Par ailleurs, le rôle de l'équipe infirmière est très important durant la période de formation et de transition vers l'HDQ ; surtout pour certains patients moins confiants avec ce traitement [46]. Les patients préfèrent des périodes de formation plus longues [47]. Il a été établi que les patients qui envisagent d'effectuer l'HDQ s'inquiètent principalement de la sécurité, de l'isolement et du soutien psychologique et logistique qu'ils pourraient avoir [48].…”