A Comparison of Hospitalization Outcomes Between Peritoneal Dialysis and Home Hemodialysis Patients by Sex and Race

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports Pub Date : 2025-05-01 DOI:10.1016/j.ekir.2025.02.012

George Worthen , Meghan Day , Leah Cahill , Louis-Charles Desbiens , Annie-Claire Nadeau-Fredette , Cindy Feng , Rachel Warren , Emilie Trinh , Jeffrey Perl , Christopher Chan , David Clark , Karthik Tennankore

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Abstract

Introduction

As interest in home dialysis as an initial dialysis modality grows, it remains unclear how the different home dialysis modalities may impact hospitalization outcomes, or how this relationship may change depending on patient sex and race.

Methods

We compared all-cause hospitalization rates and days in hospital between incident peritoneal dialysis (PD, n = 14,643) and home hemodialysis (HHD patients, n = 875) between January 2005 and December 2018 (last follow-up was in July 2020) using a nationally representative cohort of incident dialysis patients.

Results

The overall hospitalization rate was 0.82 hospitalization events per patient-year. Compared with those initiated on PD, HHD patients had a lower hospitalization rate (incident rate ratio [IRR] = 0.78, 95% confidence interval [CI] 0.71–0.85), and spent fewer days in hospital (IRR = 0.68, 95% CI: 0.59–0.78). This was more pronounced in more contemporary cohorts and for males. The protective effect of HHD was stronger for Black patients. When hospitalizations were analyzed by cause, the protective effect of HHD was stronger for infection-related admissions, with Black patients seeing the largest benefit.

Conclusion

The type of home modality at dialysis initiation is associated with differences in hospitalization outcomes, an association that is stronger in selected racial groups and sexes. While exploratory in nature, our work highlights the importance of further study on the differential impact of PD and HHD on hospitalization outcomes so that patients incident to dialysis may make an informed decision.

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不同性别和种族的腹膜透析和家庭血液透析患者住院结局的比较

随着人们对家庭透析作为一种初始透析方式的兴趣的增长，不同的家庭透析方式如何影响住院结果，或者这种关系如何根据患者的性别和种族而变化，目前尚不清楚。方法：采用具有全国代表性的透析患者队列，比较2005年1月至2018年12月（最后一次随访于2020年7月）期间，腹膜透析（PD, n = 14,643）和家庭血液透析（HHD, n = 875）的全因住院率和住院天数。结果总住院率为0.82次/患者年。与开始接受PD治疗的患者相比，HHD患者的住院率更低（发生率比[IRR] = 0.78, 95%可信区间[CI] 0.71-0.85），住院天数更短（IRR = 0.68, 95% CI: 0.59-0.78）。这在更现代的人群和男性中更为明显。HHD对黑人患者的保护作用更强。当按原因分析住院情况时，HHD对感染相关入院的保护作用更强，黑人患者获益最大。结论透析开始时家庭方式的类型与住院结果的差异相关，这种关联在特定的种族和性别群体中更为强烈。虽然是探索性的，但我们的工作强调了进一步研究PD和HHD对住院结果的差异影响的重要性，以便患者可以做出明智的决定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney International Reports Medicine-Nephrology

CiteScore

7.70

自引率

3.30%

发文量

1578

审稿时长

8 weeks

期刊介绍： Kidney International Reports, an official journal of the International Society of Nephrology, is a peer-reviewed, open access journal devoted to the publication of leading research and developments related to kidney disease. With the primary aim of contributing to improved care of patients with kidney disease, the journal will publish original clinical and select translational articles and educational content related to the pathogenesis, evaluation and management of acute and chronic kidney disease, end stage renal disease (including transplantation), acid-base, fluid and electrolyte disturbances and hypertension. Of particular interest are submissions related to clinical trials, epidemiology, systematic reviews (including meta-analyses) and outcomes research. The journal will also provide a platform for wider dissemination of national and regional guidelines as well as consensus meeting reports.