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Factors Associated With Discontinuation of Home Hemodialysis
Journal article   Open access   Peer reviewed

Factors Associated With Discontinuation of Home Hemodialysis

Rebecca Kurnik Seshasai, Nandita Mitra, C. Michael Chaknos, Jiaqi Li, Christopher Wirtalla, Dan Negoianu, Joel D. Glickman, Laura M. Dember and Jingjing Li
American journal of kidney diseases, v 67(4), pp 629-637
Apr 2016
DOI: https://doi.org/10.1053/j.ajkd.2015.11.003
PMID: 26709066
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc4808342View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

discontinuation end-stage renal disease (ESRD) Hemodialysis home dialysis home hemodialysis (HHD) renal replacement therapy (RRT) RRT modality technique failure technique survival US Renal Data System (USRDS)
Home hemodialysis (HHD) is associated with improved clinical and quality-of-life outcomes compared to in-center hemodialysis, but remains an underused modality in the United States. Discontinuation from HHD therapy may be an important contributor to the low use of this modality. This study aimed to describe the rate and timing of HHD therapy discontinuation, or technique failure, and identify contributing factors. Retrospective cohort study. Using data from a large dialysis provider, we identified a nationally representative cohort of patients who initiated HHD therapy from 2007 to 2009 (N=2,840). Demographics, end-stage renal disease duration, kidney transplant listing status, comorbid conditions, level of urbanization or rurality based on residence zip code, socioeconomic status based on residence zip code, and dialysis facility factors. Discontinuation from HHD therapy, defined as 60 or more days with no HHD treatments. Competing-risk models were used to produce cumulative incidence plots and identify sociodemographic and clinical variables associated with HHD therapy discontinuation. Transplantation and death were treated as competing risks for HHD therapy discontinuation. The 1-year incidence of discontinuation was 24.9%, and the 1-year mortality estimate was 7.6%. Median end-stage renal disease duration prior to initiating HHD therapy was 2.1 years. Diabetes and smoking/alcohol/drug use were associated with increased risk for HHD discontinuation (HRs of 1.34 [95% CI, 1.07-1.68] and 1.34 [95% CI, 1.01-1.78], respectively). Listing for kidney transplantation and rural residence (rural-urban commuting area ≥ 7) were associated with decreased risk for HHD therapy discontinuation (HRs of 0.73 [95% CI, 0.61-0.87] and 0.78 [95% CI, 0.59-1.02], respectively). Limited to variables available within the DaVita dialysis and US Renal Data System data sets. A substantial proportion of patients discontinue HHD therapy within the first 12 months of use of the modality. Patients with diabetes, substance use, nonlisting for kidney transplantation, and urban residence are at greater risk for discontinuation. Targeting high-risk patients for increased support from clinical teams is a potential strategy for reducing HHD therapy discontinuation and increasing technique survival.

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39 citations in Web of Science
45 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Urology & Nephrology
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