Home Dialysis Transitions in Canada During the COVID-19 Pandemic: An Interrupted Time Series Analysis.

ABSTRACT:

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.

SUBMITTER: Verrelli D 

PROVIDER: S-EPMC12856449 | biostudies-literature | 2026 Feb

REPOSITORIES: biostudies-literature