Study: Assessing the Impact of Dialysis Modality on Hospitalization in a Large Population of End Stage Kidney Disease Patients

Although COVID-19 (coronavirus) is a focus of the nephrology community and most of the world currently, clinical research has been and continues to be conducted on other important topics. This post on a recent study titled “Assessing the Impact of Dialysis Modality on Hospitalization in a Large Population of End Stage Kidney Disease Patients —as well as future DaVita Medical Insights posts that have yet to be published—highlight DaVita clinical study data presented at the last American Society of Nephrology (ASN) Kidney Week conference in November 2019.

Hospitalizations and readmissions pose a significant burden to end stage kidney disease (ESKD) patients and result in significant costs to the US health care system. There is increasing focus on improved clinical outcomes and medical cost savings in patients starting ESKD treatment on a home dialysis modality. Understanding the impact that specific modalities can have on hospitalizations may assist in changing physician behavior regarding initial modality selection. The Home Dialysis team of DaVita Kidney Care compared the characteristics of hospitalizations among a contemporary population of in-center hemodialysis (ICHD), peritoneal dialysis (PD), and home hemodialysis (HHD) patients.

Assessments were made as 12-month rolling averages in adult patients receiving dialysis between March 2016 and March 2019. Hospitalization rates during the study period were 1.80, 1.24, and 1.41 admissions per patient year for ICHD, PD, and HHD patients, respectively. Readmission to the hospital occurred in 32.1%, 26.2%, and 24.3% of ICHD, PD, and HHD patients, respectively. Frequent causes of initial hospital admissions included:

• Respiratory, which were more common in ICHD (11.6%) than PD (6.5%) or HHD patients (8.6%)
• Infection, which were more common in PD (14.5%) and HHD (15.4%) than ICHD patients (8.6%)
• Gastrointestinal, which were also more common among PD (12.8%) and HHD (11.5%) than in ICHD patients (9.9%)

Hospitalization rates also differed by size of the PD or HHD program. PD patient hospitalization rates were 1.55, 1.24, and 1.18 admissions per patient year for clinics with less than 10, 10 to 30, and more than 30 PD patients on the roster, respectively. HHD patient hospitalization rates were 1.51, 1.36, and 1.35 admissions per patient year for clinics with less than 9, 9 to 18, and more than 18 HHD patients on the roster, respectively.

This study demonstrated that initial hospitalization and readmission rates were consistently lower for patients on home dialysis (PD and HHD) than those receiving ICHD. The pattern of hospitalization causes differed between modalities, indicating the need for modality-specific hospitalization risk reduction strategies. Compared with clinics that have small home programs, clinics with larger home dialysis programs had lower hospitalization rates.

For more information, read the research poster (which was presented at ASN), here.

The DaVita Home Dialysis team continues to evaluate hospitalization rates in dialysis patients.