Socioeconomic differences in the uptake of home dialysis

Grace, Blair S., Clayton, Philip A., Gray, Nicholas A. and McDonald, Stephen P. (2015) Socioeconomic differences in the uptake of home dialysis. Clinical Journal of the American Society of Nephrology, 9 5: 929-935. doi:10.2215/CJN.08770813

Author Grace, Blair S.
Clayton, Philip A.
Gray, Nicholas A.
McDonald, Stephen P.
Title Socioeconomic differences in the uptake of home dialysis
Journal name Clinical Journal of the American Society of Nephrology   Check publisher's open access policy
ISSN 1555-9041
Publication date 2015-05-07
Year available 2014
Sub-type Article (original research)
DOI 10.2215/CJN.08770813
Open Access Status DOI
Volume 9
Issue 5
Start page 929
End page 935
Total pages 7
Place of publication Washington, DC, United States
Publisher American Society of Nephrology
Language eng
Formatted abstract
Background and objectives: Home dialysis creates fewer lifestyle disruptions while providing similar or better outcomes than in-center hemodialysis. Socioeconomically advantaged patients are more likely to commence home dialysis (peritoneal dialysis and home hemodialysis) in many developed countries. This study investigated associations between socioeconomic status and uptake of home dialysis in Australia, a country with universal access to health care and comparatively high rates of home dialysis.

Design, setting, participants, & measurements: This study analyzed 23,281 non-Indigenous adult patients who commenced chronic RRT in Australia from 2000 to 2011 according to the Australia and New Zealand Dialysis and Transplant Registry in a retrospective cohort study. This study investigated the proportion of patients who were ever likely to use home dialysis using nonmixture cure models and followed patients until the end of 2011 (median follow-up time=3.0 years, interquartile range=1.3–5.5 years). The main predictor was area socioeconomic status from postcodes grouped into quartiles using standard indices.

Results: Patients from the most advantaged quartile of areas were less likely to commence peritoneal dialysis (odds ratio, 0.63; 95% confidence interval, 0.58 to 0.69) and more likely to use in-center hemodialysis than patients from the most disadvantaged areas (odds ratio, 1.19; 95% confidence interval, 1.10 to 1.30). Socioeconomic status was not associated with uptake of home hemodialysis. Rural areas were more disadvantaged and had higher rates of peritoneal dialysis, and privately funded hospitals rarely used home dialysis. Patients from the most advantaged quartile of areas were more likely to use private hospitals than patients from the most disadvantaged quartile (odds ratio, 5.9; 95% confidence interval, 4.6 to 7.5).

Conclusion: The lower incidence of peritoneal dialysis among patients from advantaged areas seems to be multifactorial. Identifying and addressing barriers to home dialysis in Australia could improve patient quality of life and reduce costs.
Keyword Peritoneal dialysis
Epidemiology and outcomes
Clinical epidemiology
Stage renal disease
Peritoneal dialysis
Replacement therapy
Modality selection
Kidney disease
Esrd patients
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print April 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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