Trends in home dialysis use differ among age categories in past two decades: a Dutch registry study.

BACKGROUND: Although the number of patients with end stage kidney disease is growing, the number of patients that perform dialysis at home has decreased during the past two decades. The aim of this study is to explore time trends in the use of home dialysis in the Netherlands.

METHODS: Dialysis episodes of patients who started dialysis treatment were studied using Dutch registry data (RENINE). The uptake of home dialysis between 1997 through 2016 was evaluated in time periods of 5 years. Home dialysis was defined as start with peritoneal dialysis or home haemodialysis, or transfer to either within 2 years of dialysis initiation. All analyses were stratified for age categories. Mixed model logistic regression analysis was used to adjust for clustering at patient level.

RESULTS: A total of 33,340 dialysis episodes in 31,569 patients were evaluated. Mean age at dialysis initiation increased from 62.5±14.0 to 65.5±14.5 years in in-centre haemodialysis patients, whereas it increased from 51.9±15.1 to 62.5±14.6 years in home dialysis patients. In patients < 65 years, the uptake of home dialysis was significantly lower during each 5-year period compared to the previous period, whereas kidney transplantation occurred more often. In patients ≥ 65 years, incidence of home dialysis remained constant, whereas mortality decreased.

CONCLUSIONS: In patients < 65 years, the overall use of home dialysis declined consistently over the past 20 years. The age of home dialysis patients increased more rapidly than that of in-centre dialysis patients. These developments have a significant impact on the organisation of home dialysis.