An integrated home dialysis model facilitates transition from peritoneal dialysis to self-care hemodialysis: evidence from a Belgian cohort

Abstract Background Peritoneal dialysis (PD) is an effective, patient-centered, cost-efficient kidney replacement therapy (KRT) that preserves autonomy. However, long-term PD survival is limited, and many patients eventually transfer to hemodialysis (HD). Transition to self-care HD remains rare (10%), with most patients moving to in-center HD. We evaluated whether an integrated self-care dialysis program—encompassing PD, home HD and satellite self-care HD—could improve transition rates from PD to self-care HD. Methods We conducted a retrospective, single-center cohort study including all incident adult PD patients at Cliniques universitaires Saint-Luc, Brussels, between 2010 and 2021. Pediatric patients, those still on PD, or transferred elsewhere were excluded. Baseline clinical characteristics, comorbidities, and outcomes were compared between patients transitioning from PD to in-center HD versus self-care HD (home HD or satellite). Results Among 112 patients, 45 transitioned from PD to HD: 24 (53.3%) to in-center HD, 14 (31.1%) to home HD, and 7 (15.6%) to satellite self-care HD. Nearly half (47%) transitioned to a self-care modality. Compared with in-center HD patients, self-care HD patients were younger (45 vs 67 years), more frequently female, had lower comorbidity scores, and were more often listed for transplantation. Causes of transition differed: inadequate dialysis predominated in self-care HD, while infections and mechanical complications were more frequent in in-center HD. Mortality was lower in self-care HD; transplantation rates were similar. Conclusions Integrated home dialysis programs facilitate transitions from PD to self-care HD, preserve autonomy, and improve survival, supporting a “PD first, self-care HD second” approach.