Home versus In-Center Dialysis and Day of the Week Hospitalization: A Cohort Study

Abstract

Background: The dialysis treatment day after the 2-day interdialytic interval (Monday/Tuesday) is associated with a heightened risk of hospitalization for patients on in-center hemodialysis (ICHD). In this national cohort study, we sought to characterize hospitalizations by day of the week for patients receiving ICHD, home HD (HHD), and peritoneal dialysis (PD) and to identify whether there were differences in the probability of a Monday/Tuesday admission for each modality type.

Methods: Patients on maintenance dialysis in Canada were analyzed from 2005 to 2014 using the Canadian Organ Replacement Register. Patients on hemodialysis were categorized as those receiving ICHD, HHD, frequent ICHD, or frequent HHD (the latter two included short daily and nocturnal HD). Hospitalizations were attributed to the previous treatment if they occurred within 30 days of a treatment change. Differences in the proportion of patients experiencing a Monday/Tuesday admission with all other days of the week were compared using a generalized linear model with binomial distribution and reported using adjusted odds ratios (OR) with 95% CIs.

Results: Overall, 27,430 individuals experienced 111,748 hospitalization episodes. Rates per 1000 patient days were 3.76, 2.98, 2.71, 2.16, and 2.13 for each of frequent ICHD, ICHD, PD, HHD, and frequent HHD, respectively. Compared with those on ICHD, only patients receiving frequent HHD (OR, 0.89; 95% CI, 0.81 to 0.97) and PD (OR, 0.95; 95% CI, 0.93 to 0.97) had a lower odds of experiencing a Monday/Tuesday admission. The OR was lower when restricted to hospitalization episodes for cardiovascular reasons comparing frequent HHD with ICHD (OR, 0.68; 95% CI, 0.48 to 0.96).

Conclusion: In this nationally representative cohort, we identified that the probability of a Monday/Tuesday admission was lower for frequent HHD and PD compared with ICHD, most notably for hospitalizations due to cardiovascular causes. Gaining a better understanding of the reasons behind this observation may help to develop future strategies to reduce overall and cause-specific hospitalization for patients receiving dialysis.

Keywords: cohort study; daily hemodialysis; day of week; dialysis; home hemodialysis; hospitalization; nocturnal dialysis; peritoneal dialysis.

Graphical abstract

Figure 1.

Rates of hospitalization for each day of the week, stratified by dialysis modality. For all modality groups, the rate of weekend day admissions (i.e., an admission on a Saturday or Sunday) was lower than the other days of the week. Hours per treatment and treatment frequencies for hemodialysis were as follows: in-center hemodialysis (ICHD)/home hemodialysis (HHD), 3–6 hours, two to four times per week; frequent ICHD/frequent HHD, >6 hours, five to six nights per week, and 2–3 hours, 5–7 d/wk.

Figure 2.

Radar plot of day of the week admission (proportion). (A) ICHD and (B) frequent ICHD. Patients receiving ICHD and frequent ICHD experienced the highest proportion of hospitalizations on Monday and Tuesday. Hours per treatment and treatment frequencies for ICHD, 3–6 hours, two to four times per week; frequent ICHD, >6 hours, five to six nights per week, and 2–3 hours, 5–7 d/wk. ICHD, in-center hemodialysis.

Figure 3.

Radar plots of day of the week admission (proportion). (A) frequent HHD, (B) HHD, and (C) peritoneal dialysis. Patients receiving HHD experienced the highest proportion of hospitalizations on Monday and Tuesday, but this finding was not observed for those receiving frequent HHD. Patients receiving peritoneal dialysis had a more consistent risk of admission for each non weekend day of the week. Hours per treatment and treatment frequencies were as follows: HHD, 3–6 hours, two to four times per week; frequent HHD, >6 hours, five to six nights per week, and 2–3 hours, 5–7 d/wk. HHD, home hemodialysis.

Figure 4.

Unadjusted and adjusted odds ratios (95% CIs) of a Monday/Tuesday admission comparing HHD, frequent ICHD, peritoneal dialysis, and frequent HHD (reference: ICHD). Patients receiving frequent HHD had a lower adjusted odds of a Monday/Tuesday admission (versus all other days) compared with those on ICHD. Patients receiving PD also had a small, but statistically significant, lower odds of Monday/Tuesday admission. Hours per treatment and treatment frequencies for hemodialysis were as follows: ICHD/HHD, 3–6 hours, two to four times per week; frequent ICHD/frequent HHD, >6 hours, five to six nights per week, and 2–3 hours, 5–7 d/wk. CIs, confidence intervals; ICHD, in-center hemodialysis; HHD, home hemodialysis.