Background: In the United Kingdom, socioeconomic disadvantage has been associated with lower use of home dialysis, mostly peritoneal dialysis. In this study, we explore the role of a patient's sociodemographic, socioeconomic differences and the centre's influence on home haemodialysis (HD) prevalence. Methods: Data is derived from the cross-sectional arm of the UK multi-centre study investigating barriers and enablers of home HD (BASIC-HHD study). Centres were classified as low- (<3%), medium- (5-8%) and high-prevalence groups (>8%). Sociodemographic and socioeconomic status data were ascertained. Patients were enrolled in hospital HD (n = 213), home HD (n = 93) and predialysis groups (n = 222). Results: The treating renal centre to which the patient belonged was significantly associated with a patient's modality in prevalent HD groups and modality-choice in the “predialysis” group, in confounder-adjusted multivariable analyses. Non-white ethnicity was associated with lower odds of self-care dialysis modality choice (OR 0.21, 95% CI 0.07-0.62) and lower odds of home HD uptake in the prevalent HD group (OR 0.24, 95% CI 0.07-0.80). Other significant associations of home HD uptake in the HD cohort included lower age (OR 0.59, 95% CI 0.39-0.89), higher education (OR 2.99, 95% CI 1.25-7.16), home ownership (OR 0.26, 95% CI 0.09-0.70), childcare responsibility (OR 0.22, 95% CI 0.08-0.66) and unrestricted mobility (OR 0.31, 95% CI 0.11-0.91). Conclusion: “Centre” effect accounts for variation in home HD prevalence between renal units after accounting for sociodemographic parameters and co-morbidities. Unit practices and attitudes to home HD are likely to have a dominating impact on home HD prevalence rates and these aspects need to be explored systematically at the organisational level.

Keywords:
Demographics, Self-care haemodialysis, Home haemodialysis, Socioeconomic status
1.
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AY, Yang CW: Chronic kidney disease: global dimension and perspectives. Lancet 2013;382:260-272.
2.
McFarlane P, Bayoumi AM, Pierratos A, Redelmeier DA: The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis. Kidney Int 2003;64:1004-1011.
3.
Kutner NG: Quality of life and daily hemodialysis. Semin Dial 2004;17:92-98.
4.
Mowatt G, Vale L, MacLeod A: Systematic review of the effectiveness of home versus hospital or satellite unit hemodialysis for people with end-stage renal failure. Int J Technol Assess Health Care 2004;20:258-268.
5.
Komenda P, Copland M, Makwana J, Djurdjev O, Sood MM, Levin A: The cost of starting and maintaining a large home hemodialysis program. Kidney Int 2010;77:1039-1045.
6.
Komenda P, Gavaghan MB, Garfield SS, Poret AW, Sood MM: An economic assessment model for in-center, conventional home, and more frequent home hemodialysis. Kidney Int 2012;81:307-313.
7.
Stokes JB: Nocturnal hemodialysis: analysis following the frequent hemodialysis network trial. Semin Dial 2011;24:614-620.
8.
Marshall MR, Hawley CM, Kerr PG, Polkinghorne KR, Marshall RJ, Agar JW, McDonald SP: Home hemodialysis and mortality risk in Australian and New Zealand populations. Am J Kidney Dis 2011;58:782-793.
9.
Marshall MR, Walker RC, Polkinghorne KR, Lynn KL: Survival on home dialysis in New Zealand. PLoS One 2014;9:e96847.
10.
Chiu YW, Jiwakanon S, Lukowsky L, Duong U, Kalantar-Zadeh K, Mehrotra R: An update on the comparisons of mortality outcomes of hemodialysis and peritoneal dialysis patients. Semin Nephrol 2011;31:152-158.
11.
McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR: Relationship between dialysis modality and mortality. J Am Soc Nephrol 2009;20:155-163.
12.
Walker DR, Inglese GW, Sloand JA, Just PM: Dialysis facility and patient characteristics associated with utilization of home dialysis. Clin J Am Soc Nephrol 2010;5:1649-1654.
13.
Grace BS, Clayton PA, Gray NA, McDonald SP: Socioeconomic differences in the uptake of home dialysis. Clin J Am Soc Nephrol 2014;9:929-935.
14.
Castledine C, Gilg J, Rogers C, Ben-Shlomo Y, Caskey F: UK Renal Registry 13th Annual Report (December 2010): chapter 15: UK renal centre survey results 2010: RRT incidence and use of home dialysis modalities. Nephron Clin Pract 2011;119(suppl 2):c255-c267.
15.
Castledine CI, Gilg JA, Rogers C, Ben-Shlomo Y, Caskey FJ: How much of the regional variation in RRT incidence rates within the UK is explained by the health needs of the general population? Nephrol Dial Transplant 2012;27:3943-3950.
16.
Castledine CI, Gilg JA, Rogers C, Ben-Shlomo Y, Caskey FJ: Renal centre characteristics and physician practice patterns associated with home dialysis use. Nephrol Dial Transplant 2013;28:2169-2180.
17.
Castledine C, Casula A, Fogarty D: Chapter 2 UK RRT prevalence in 2010: national and centre-specific analyses. Nephron Clin Pract 2012;120(suppl 1):c29-c54.
18.
Jayanti A, Wearden AJ, Morris J, Brenchley P, Abma I, Bayer S, Barlow J, Mitra S: Barriers to successful implementation of care in home haemodialysis (BASIC-HHD): 1. Study design, methods and rationale. BMC Nephrol 2013;14:197.
19.
Jager KJ, Zoccali C, Macleod A, Dekker FW: Confounding: what it is and how to deal with it. Kidney Int 2008;73:256-260.
20.
Udayaraj UP, Ben-Shlomo Y, Roderick P, Casula A, Ansell D, Tomson CR, Caskey FJ: Socio-economic status, ethnicity and geographical variations in acceptance rates for renal replacement therapy in England and Wales: an ecological study. J Epidemiol Community Health 2010;64:535-541.
21.
Bouvier N, Durand PY, Testa A, Albert C, Planquois V, Ryckelynck JP, Lobbedez T: Regional discrepancies in peritoneal dialysis utilization in France: the role of the nephrologist's opinion about peritoneal dialysis. Nephrol Dial Transplant 2009;24:1293-1297.
22.
Jayanti A, Morris J, Stenvinkel P, Mitra S: Home hemodialysis: beliefs, attitudes, and practice patterns. Hemodial Int 2014;18:767-776.
23.
Mattern WD, McGaghie WC, Rigby RJ, Nissenson AR, Dunham CB, Khayrallah MA: Selection of ESRD treatment: an international study. Am J Kidney Dis 1989;13:457-464.
24.
Goovaerts T, Jadoul M, Goffin E: Influence of a pre-dialysis education programme (PDEP) on the mode of renal replacement therapy. Nephrol Dial Transplant 2005;20:1842-1847.
25.
Tennankore KK, Hingwala J, Watson D, Bargman JM, Chan CT: Attitudes and perceptions of nephrology nurses towards dialysis modality selection: a survey study. BMC Nephrol 2013;14:192.
26.
Abma I, Jayanti A, Bayer S, Mitra S, Barlow J: Perceptions and experiences of financial incentives: a qualitative study of dialysis care in England. BMJ Open 2014;4:e004249.
27.
Little J, Irwin A, Marshall T, Rayner H, Smith S: Predicting a patient's choice of dialysis modality: experience in a United Kingdom renal department. Am J Kidney Dis 2001;37:981-986.
28.
Chanouzas D, Ng KP, Fallouh B, Baharani J: What influences patient choice of treatment modality at the pre-dialysis stage? Nephrol Dial Transplant 2012;27:1542-1547.
29.
Marshall MR, van der Schrieck N, Lilley D, Supershad SK, Ng A, Walker RC, Dunlop JL: Independent community house hemodialysis as a novel dialysis setting: an observational cohort study. Am J Kidney Dis 2013;61:598-607.
30.
Reddy NC, Korbet SM, Wozniak JA, Floramo SL, Lewis EJ: Staff-assisted nursing home haemodialysis: patient characteristics and outcomes. Nephrol Dial Transplant 2007;22:1399-1406.
31.
Agraharkar M, Barclay C, Agraharkar A: Staff-assisted home hemodialysis in debilitated or terminally ill patients. Int Urol Nephrol 2002;33:139-144.
32.
Trehan A, Winterbottom J, Lane B, Foley R, Venning M, Coward R, MacLeod AM, Gokal R: End-stage renal disease in Indo-Asians in the North-West of England. QJM 2003;96:499-504.
33.
Mehrotra R, Soohoo M, Rivara MB, Himmelfarb J, Cheung AK, Arah OA, Nissenson AR, Ravel V, Streja E, Kuttykrishnan S, Katz R, Molnar MZ, Kalantar-Zadeh K: Racial and ethnic disparities in use of and outcomes with home dialysis in the United States. J Am Soc Nephrol 2016;27:2123-2134.
34.
Liebman SE, Bushinsky DA, Dolan JG, Veazie P: Differences between dialysis modality selection and initiation. Am J Kidney Dis 2012;59:550-557.
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2017
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