Key result
Home hemodialysis linked to ~31% lower mortality versus center hemodialysis in end-stage kidney disease.
Why the study?
Home hemodialysis offers flexibility and outcome advantages over center hemodialysis, but differences in usage and outcomes between modalities with a focus on racial/ethnic minorities needed investigation.
Does home hemodialysis improve mortality and hospitalization compared to center hemodialysis in patients with end-stage kidney disease across racial/ethnic groups?
Cohort (n=562,655)
Yes
Does home hemodialysis improve mortality and hospitalization compared to center hemodialysis in patients with end-stage kidney disease across racial/ethnic groups?
Odds Ratio: 0.686 (95% CI 0.641–0.734)
Home hemodialysis is associated with lower mortality compared to center hemodialysis across racial and ethnic groups, despite significant disparities in its utilization among minorities.
HHD was associated with lower mortality than CHD; hypothesis-generating and requires prospective confirmation before informing risk stratification.
Introduction: Home hemodialysis (HHD) offers patients with end-stage kidney disease (ESKD) greater flexibility and advantages of health outcomes over center hemodialysis (CHD). This study aims to investigate the differences between home and center hemodialysis with a focus on racial/ethnic minorities. Methods: The US Renal Disease System (USRDS) 2019 patient core data containing mortality and hospitalization which are cumulative since 2010 were merged with 2016-2019 Medicare clinical claims. To assess demographic and medical factors adjusted utilization and mortality of HHD vs CHD within every racial/ethnic cohort, logistic regression was used, and negative binomial regression was conducted to analyze the number of hospitalizations. Results: Evaluating 548,453 (97.48%) CHD patients and 14,202 (2.52%) HHD patients with Whites 47%, Blacks 32%, Hispanics 15%, Asians 4%, and other minorities 2%, the outcomes from adjusted regressions showed that: 1) minorities were significantly less likely to use HHD than Whites (Blacks: OR, 0.568, 95% CI, 0.546-0.592; Hispanics: OR, 0.510, 95% CI, 0.477-0.544; Asians: OR, 0.689, 95% CI, 0.619-0.766; Others: OR, 0.453, 95% CI, 0.390-0.525; p < 0.001); 2) most minority patients were younger and had fewer comorbidities than Whites, and all minority groups displayed significantly lower mortality and hospitalization incidences than the White group with adjustment on multiple covariates; 3) in the overall and main racial/ethnic cohorts, HHD showed a significantly lower risk of death than CHD after confounding for major risk factors (overall cohort: OR, 0.686, 95% CI, 0.641-0.734; White: OR, 0.670, 95% CI, 0.612-0.734; Blacks: OR, 0.717, 95% CI, 0.644-0.799; Hispanics: OR, 0.715, 95% CI, 0.575-0.889; Others: OR, 0.473, 95% CI, 0.265-0.844). Conclusion: There are substantial racial/ethnic variations in home hemodialysis use and health outcomes in the United States.
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Y. N. Zhu (2024) conducted a cohort in End-stage kidney disease (ESKD) (n=562,655). Home hemodialysis (HHD) vs. Center hemodialysis (CHD) was evaluated on Risk of death (mortality) (OR 0.686, 95% CI 0.641-0.734). Home hemodialysis was associated with a significantly lower risk of death compared to center hemodialysis among patients with end-stage kidney disease (OR 0.686; 95% CI 0.641-0.734).
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