Association of Social Deprivation Index with Home Dialysis Technique Failure: A Single-Center Experience

Abstract

Key Points:

1. Historically underrepresented racial groups and those with high sociodemographic stress are less likely to initiate dialysis with a home modality.

2. Differences in race are not significant in those who transition to a home dialysis modality after starting in-center hemodialysis.

3. Measures of sociodemographic stress are not associated with home dialysis technique failure.

Background: Despite offering several advantages to patients and health care systems, utilization of home dialysis modalities (HDMs) remains low, particularly among racial and ethnic minorities and those with increased sociodemographic stress. Providers' apprehension toward adverse outcomes and home dialysis failure remains a barrier to HDM referral. We investigated the relationship that sociodemographic factors have on HDM use and technique failure.

Methods: We performed a retrospective cohort study of adult patients with incident ESKD over a 6-year period at the University of Rochester to evaluate the association between demographic factors, the Social Deprivation Index (SDI), and comorbidity burden on HDM utilization and technique failure. Person-time incidence rates were calculated to compare outcome variables, and rates were compared using a Poisson Rate Ratio Test. A univariate Cox regression was used to examine predictors affecting technique failure.

Results: Of the 873 patients, 102 started dialysis with HDM, 79 patients converted to HDM, and 692 remained on in-center hemodialysis (ICHD). Age, race, and SDI scores were significantly different between patients starting on ICHD, peritoneal dialysis, and home hemodialysis with no significant difference in comorbidity burden. Black patients represented 32% of the overall cohort, but only 16% of the initial home dialysis population. Compared with those who remained on ICHD, individuals converting from ICHD to HDM were younger and had significantly different SDI scores. SDI was not associated with HDM technique failure.

Conclusions: Historically underrepresented racial populations are less represented in those starting home dialysis; however, there was no racial difference in the group transitioning to HDM after initiating ICHD. Social deprivation scores were higher in those on ICHD compared with peritoneal dialysis. Neither social deprivation nor race predicted success on home therapy. These findings demonstrate a disparity in initial modality, and a disconnect between sociodemographic factors associated with home dialysis use and those predicting HDM technique failure.

Graphical abstract

Figure 1

Home dialysis technique failure based on SDI in those starting dialysis at home. Kaplan–Meir curve depicting home dialysis failure stratified by low social deprivation (SDI ≤0.5) and high social deprivation (SDI >0.5). SDI, social deprivation index.