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Background <p>Despite efforts to increase its use, home dialysis remains underutilized as a modality for kidney replacement therapy (KRT). Home dialysis may offer an advantage in rural areas. We evaluated the role of a rural outreach program on the use of home dialysis as incident KRT modality in West Virginia.</p> Methods <p>This is a retrospective cohort study of patients with end-stage kidney disease (ESKD). Data on KRT were collected using the United States Renal Data System (USRDS) database from 1965 to 2020.</p> Results <p>Of the total 22,408 West Virginia patients who started KRT with a dialysis modality between 1965 and 2020, 3203 (14.3%) patients started with a home modality. Among patients from counties served by a rural outreach clinic providing kidney care, 896 (18%) patients started with home dialysis compared to 2306 (13%) patients from other counties. Patients from counties served by a rural outreach clinic were more likely to be White (96 vs 90%), have comorbid illness, and live in a rural community (90 vs 56%), but less likely to be unemployed (11 vs 14%), all <i>p</i> &lt; 0.001. In a multivariable model, after adjusting for comorbid medical conditions and rurality, the odds of starting dialysis with a home modality were greater for patients from counties served by a rural clinic than for patients from counties without such clinics (OR 1.4, 95% CI 1.15–1.7).</p> Conclusion <p>Patients with ESKD from West Virginia counties served by rural outreach clinics were more likely to initiate KRT by a home-based modality than patients from other counties in West Virginia.</p> Graphical abstract <p></p>

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Home dialysis as the incident modality in patients starting dialysis in West Virginia: role of the rural outreach kidney care clinic

  • 期刊论文

  • 发表日期：

    2025年3月1日

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  • Rebecca Schmidt,
  • Anthony Parravani,
  • Mark Poling,
  • Anas Diab,
  • Bethany Pellegrino,
  • Khaled Shawwa

摘要

Background

Despite efforts to increase its use, home dialysis remains underutilized as a modality for kidney replacement therapy (KRT). Home dialysis may offer an advantage in rural areas. We evaluated the role of a rural outreach program on the use of home dialysis as incident KRT modality in West Virginia.

Methods

This is a retrospective cohort study of patients with end-stage kidney disease (ESKD). Data on KRT were collected using the United States Renal Data System (USRDS) database from 1965 to 2020.

Results

Of the total 22,408 West Virginia patients who started KRT with a dialysis modality between 1965 and 2020, 3203 (14.3%) patients started with a home modality. Among patients from counties served by a rural outreach clinic providing kidney care, 896 (18%) patients started with home dialysis compared to 2306 (13%) patients from other counties. Patients from counties served by a rural outreach clinic were more likely to be White (96 vs 90%), have comorbid illness, and live in a rural community (90 vs 56%), but less likely to be unemployed (11 vs 14%), all p < 0.001. In a multivariable model, after adjusting for comorbid medical conditions and rurality, the odds of starting dialysis with a home modality were greater for patients from counties served by a rural clinic than for patients from counties without such clinics (OR 1.4, 95% CI 1.15–1.7).

Conclusion

Patients with ESKD from West Virginia counties served by rural outreach clinics were more likely to initiate KRT by a home-based modality than patients from other counties in West Virginia.

Graphical abstract