Kidney medicine · 2025
Home Dialysis Transitions in Canada During the COVID-19 Pandemic: An Interrupted Time Series Analysis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Verrelli Davide, Whitlock Reid, Ferguson Thomas, Rigatto Claudio, Nickel Nathan, Tennankore Karthik, Harasemiw Oksana, Brar Ranveer, Bohm Clara
Аннотация
RATIONALE & OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, nephrology societies recommended transition from facility-based hemodialysis to home dialysis to minimize risks associated with COVID-19 infection. We compared transition rates from facility-based hemodialysis to home dialysis and rates and reasons for transfers from home dialysis to facility-based hemodialysis before and during the pandemic in Canada.
STUDY DESIGN: Interrupted time-series analysis.
SETTING & POPULATION: Using administrative data from the Canadian Organ Replacement Register, our cohort included 31,596 and 22,607 adults with any time receiving hemodialysis during the prepandemic and pandemic study periods, respectively.
EXPOSURE: Early pandemic (April 1, 2020-September 30, 2021) versus prepandemic (January 1, 2016-December 31, 2019).
OUTCOMES: Monthly rates of transitions between facility-based hemodialysis and home dialysis as well as reasons for transfer from home to facility.
ANALYTICAL APPROACH: Segmented linear regression and analysis of covariance.
RESULTS: During the early pandemic, transitions to home dialysis increased by 0.60 per 10,000 patients/month (95% CI, 0.08 to 1.11; P = 0.03), beyond the nonsignificant monthly prepandemic trend of 0.02 per 10,000 (95% CI, -0.10 to 0.13; P = 0.80). Monthly transfers from home dialysis to facility-based hemodialysis per 10,000 home dialysis patients also increased during the pandemic (6.91; 95% CI, 3.42 to 10.40; P < 0.001) versus the prepandemic period (-1.78; 95% CI, -4.31 to0.75; P = 0.20). The rate of increase in home-to-facility transfers during the pandemic was not significantly different than facility-to-home transfers (-0.10 transfers/month; 95% CI, -1.51 to 1.31; P = 0.89). More transfers to facility occurred for geographic/resource-related reasons during the pandemic versus prepandemic (5.8% vs 2.7%; P < 0.0001).
LIMITATIONS: Inability to analyze change in trends by province and ecological bias.
CONCLUSIONS: Transitions from facility-based hemodialysis to home dialysis increased, suggesting kidney care programs in Canada implemented recommendations intended to decrease COVID-19-related risks in this population. Reasons for the observed increase in transfers from home to facility during the pandemic are unclear.
STUDY DESIGN: Interrupted time-series analysis.
SETTING & POPULATION: Using administrative data from the Canadian Organ Replacement Register, our cohort included 31,596 and 22,607 adults with any time receiving hemodialysis during the prepandemic and pandemic study periods, respectively.
EXPOSURE: Early pandemic (April 1, 2020-September 30, 2021) versus prepandemic (January 1, 2016-December 31, 2019).
OUTCOMES: Monthly rates of transitions between facility-based hemodialysis and home dialysis as well as reasons for transfer from home to facility.
ANALYTICAL APPROACH: Segmented linear regression and analysis of covariance.
RESULTS: During the early pandemic, transitions to home dialysis increased by 0.60 per 10,000 patients/month (95% CI, 0.08 to 1.11; P = 0.03), beyond the nonsignificant monthly prepandemic trend of 0.02 per 10,000 (95% CI, -0.10 to 0.13; P = 0.80). Monthly transfers from home dialysis to facility-based hemodialysis per 10,000 home dialysis patients also increased during the pandemic (6.91; 95% CI, 3.42 to 10.40; P < 0.001) versus the prepandemic period (-1.78; 95% CI, -4.31 to0.75; P = 0.20). The rate of increase in home-to-facility transfers during the pandemic was not significantly different than facility-to-home transfers (-0.10 transfers/month; 95% CI, -1.51 to 1.31; P = 0.89). More transfers to facility occurred for geographic/resource-related reasons during the pandemic versus prepandemic (5.8% vs 2.7%; P < 0.0001).
LIMITATIONS: Inability to analyze change in trends by province and ecological bias.
CONCLUSIONS: Transitions from facility-based hemodialysis to home dialysis increased, suggesting kidney care programs in Canada implemented recommendations intended to decrease COVID-19-related risks in this population. Reasons for the observed increase in transfers from home to facility during the pandemic are unclear.