Initial home dialysis is increased for rural patients by accessing urban facilities

Background: The 240,000 rural patients with end stage kidney disease in the United States have less access to nephrology care and higher mortality than those in urban settings. The Advancing American Kidney Health initiative aims to increase the use of home renal replacement therapy. Little is known about how rural patients access home dialysis and the availability and quality of rural dialysis facilities. Methods: Incident dialysis patients in 2017 and their facilities were identified in the United States Renal Data System. Facility quality and service availability was analyzed with descriptive statistics. We assessed the availability of home dialysis methods depending on rural versus urban counties, and then we used multivariate logistic regression to identify the likelihood of rural patients with home dialysis as their initial modality and the likelihood of rural patients changing to home dialysis within 90 days. Finally, we assessed mortality after dialysis initiation based on patient home location. Results: Of the 97,930 dialysis initiates, 15,310 (15.6%) were rural. Rural dialysis facilities were less likely to offer home dialysis (51.4% vs 54.1%, P<0.001). While a greater proportion of rural patients (9.2 vs 8.2%, P<0.001) were on home dialysis, this was achieved by traveling to urban facilities to obtain home dialysis (OR 2.74, P<0.001). After adjusting for patient and facility factors, rural patients had a higher risk of mortality (HR 1.06, P=0.004). Conclusions: Despite having fewer facilities that offer home dialysis, rural patients were more often on home dialysis methods because they traveled to urban facilities, representing an access gap. Even if rural patients accessed home dialysis at urban facilities, rural patients still suffered worse mortality. Future dialysis policy should address this access gap to improve care and overall mortality for rural patients.

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Travel Distance and Home Dialysis Rates in the United States

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00234 ◽

2014 ◽

Vol 34 (1) ◽

pp. 24-32 ◽

Cited By ~ 13

Author(s):

Suma Prakash ◽

Rick Coffin ◽

Jesse Schold ◽

Steven A. Lewis ◽

Douglas Gunzler ◽

...

Keyword(s):

United States ◽

The United States ◽

Travel Distance ◽

Home Dialysis ◽

Future Studies ◽

Logistic Regression Models ◽

Dialysis Facility ◽

Dialysis Facilities ◽

Specific Barriers ◽

Travel Distances

IntroductionRural residence is associated with increased peritoneal dialysis (PD) utilization. The influence of travel distance on rates of home dialysis utilization has not been examined in the United States. The purpose of this study was to determine whether travel distances to the closest home and in-center hemodialysis (IHD) facilities are a barrier to home dialysis.MethodsThis was a retrospective cohort study of patients aged ≥ 18 years initiating dialysis between 2005 and 2011. Unadjusted PD and home hemodialysis (HHD) rates were compared by travel distances to both the closest home dialysis and closest IHD facilities. Adjusted PD and HHD utilization rates were examined using multivariable Logistic regression models.ResultsThere were 98,608 patients in the adjusted analyses. 55.5% of the dialysis facilities offered home dialysis. IHD, PD and HHD patients traveled median distances of 5.4,3.5 and 6.6 miles respectively to their initial dialysis facilities. Unadjusted analyses showed an increase in PD rates and decrease in HHD rates with increased travel distances. Adjusted odds of PD and HHD were 1.6 and 1.2 respectively for a ten mile increase in distance to the closest home dialysis facility, while for distances to the closest IHD facility the odds ratios for both PD and HHD were 0.7 (all p< 0.01).ConclusionsIn metropolitan areas, PD and HHD generally increased with increased travel distance to the closest home dialysis facility and decreased with greater distance to an IHD facility. Examination of travel distances to PD and HHD facilities separately may provide further insight on specific barriers to these modalities which can serve as targets for future studies examining expansion of home dialysis utilization.

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The association between prevalence of peritoneal dialysis vs hemodialysis and patients' distance to dialysis-providing facilities

Kidney360 ◽

10.34067/kid.0004762021 ◽

2021 ◽

pp. 10.34067/KID.0004762021

Author(s):

Pattharawin Pattharanitima ◽

Osama El Shamy ◽

Kinsuk Chauhan ◽

Aparna Saha ◽

Huei Hsun Wen ◽

...

Keyword(s):

United States ◽

The United States ◽

Dialysis Modality ◽

End Stage Kidney Disease ◽

Distance Analysis ◽

Straight Line ◽

Straight Line Distance ◽

Dialysis Facilities ◽

End Stage

Background: Accessibility to dialysis facilities plays a central role when deciding on a patient's long-term dialysis modality. Studies investigating the effect of distance to nearest dialysis-providing unit on modality choice have yielded conflicting results. We set out to investigate the association between patients' dialysis modality and both the driving and straight-line distances to the closest HD- and PD-providing units. Methods: All end stage kidney disease patients who initiated in-center HD and PD in 2017, 18-90 years old, and on dialysis for ≥30 days were included. Patients in residence zip codes in non-conterminous United States or lived >90 miles from the nearest HD-providing unit were excluded. Results: 102,247 patients in the United States initiated in-center HD and PD in 2017. Compared to HD patients, PD patients had longer driving distances to their nearest PD unit (4.4 vs 3.4 miles; p <0.001). Patients who lived >30 miles from the nearest HD unit were more likely to be on PD if the nearest PD unit was a distance equal to/less than the HD unit. PD utilization increased with increasing distance from patients' homes to the nearest HD unit. No change in this association was found regardless of if the PD unit was farther/closer than the nearest HD unit. This association was not seen with straight line distance analysis. Conclusions: With increasing distances from the nearest dialysis providing units (HD or PD), PD utilization increased. Using driving distance rather than straight line distance affects data analysis and outcomes. Increasing the number of PD units may have a limited impact on increasing PD utilization.

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Underutilization of Home Dialysis in the United States: missed opportunities for quality improvement.

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v1i2.46 ◽

2018 ◽

Vol 1 (2) ◽

pp. 59-64

Author(s):

Vo D Nguyen

Keyword(s):

United States ◽

Peritoneal Dialysis ◽

National Policy ◽

The United States ◽

Data System ◽

Missed Opportunities ◽

Home Dialysis ◽

The Us ◽

Stage Renal Disease ◽

End Stage

Peritoneal dialysis may offer many potential advantages over in-center hemodialysis: lower cost, better quality of care and lower mortality. However, the United States Renal Data System (USRDS) which is a national data system that collects, analyzes, and distributes information about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States, indicates that the incidence and prevalence of home dialysis remains under-utilized compared with in-center hemodialysis. Future changes in national policy on dialysis may bring about an increase in home dialysis and potentially improve the care and cost in dialysis. This paper is mostly based on the 2017 USRDS Annual Report and centered on the potential missed opportunity caused by the underuse of peritoneal dialysis in the US.

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Emergent Dialysis and its Impact on Quality of Life in Undocumented Patients with End-Stage Renal Disease

Ethnicity & Disease ◽

10.18865/ed.27.1.39 ◽

2017 ◽

Vol 27 (1) ◽

pp. 39 ◽

Cited By ~ 8

Author(s):

Andrew N. Hogan ◽

William R. Fox ◽

Lynn P. Roppolo ◽

Robert E. Suter

Keyword(s):

Quality Of Life ◽

United States ◽

End Stage Renal Disease ◽

The United States ◽

Dialysis Patients ◽

Study Population ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Objective: This study aimed to define the ethnographic composition and assess the health-related quality of life (HRQoL) of a large population of undocumented patients with end-stage renal disease (ESRD) seeking emergent dialysis in the emergency department (ED) of a large public hospital in the United States.Design: All ESRD patients presenting to the hospital’s main ED were identified during a 4-week consecutive enrollment period. Consenting patients completed two surveys—an ethnographic questionnaire and the validated kidney disease quality of life-36 (KDQOL-36) instrument.Setting: The study was conducted at a large county hospital in Dallas, Texas. In 2013, the hospital recorded >50,000 ED visits and administered approximately 6,000 dialysis treatments to ED patients.Participants: 88 of 101 unfunded patients presenting to the ED during the study period consented to participate, resulting in an 87.1% response rate. 65 of these patients were undocumented immigrants.Main Outcome Measures: Quantitative scores for the 5 subscales of the KDQOL-36 were calculated for the study population.Results: Measures of physical and mental health in our study population were lower than those published for scheduled dialysis patients. 79.5% of our patients lost employment due to their dialysis requirements. At least 71.4% of the study patients were unaware that they required dialysis before immigrating to the United States.Conclusions: Quality of life scores were found to be low among our population of undocumented emergent dialysis patients. Our data also provide some evidence that availability of dialysis at no cost is not a primary driver of illegal immigration of ESRD patients to the United States.Ethn Dis. 2017;27(1):39-44; doi:10.18865/ed.27.1.39.

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