Among patients with kidney failure in skilled nursing facilities (SNFs), performing on-site more frequent dialysis (MFD) may lead to faster discharge to home, suggests a study in the open-access journal Kidney360.
The retrospective-prospective observational study included all patients with kidney failure newly admitted to an on-site dialysis service at 195 SNFs across 12 states. Analyses focused on the outcomes of MFD— targeting 14 hours of treatment over five sessions per week— compared with conventional, three-times-weekly dialysis. A 90-day cumulative incidence of home discharge was compared between groups, along with safety issues related to competing risks of hospitalization and death.
The analysis included 10,246 MFD episodes and 3451 conventional dialysis episodes. Patients receiving MFD had a higher mean age and were “consistently sicker” than those receiving conventional dialysis, with a first systolic blood pressure in more patients; lower hemoglobin and iron saturation; increased comorbidity; and higher rates of complicated diabetes, cerebrovascular disease, and congestive heart failure.
Despite these adverse characteristics, patients receiving MFD were more likely to be discharged to home within 42 days: 17.5% compared with 14% for those receiving conventional dialysis. Safety outcomes were similar between groups, with no increase in hospitalization or mortality.
The authors previously reported beneficial effects of MFD among patients with kidney failure at SNFs within a national service organization. The new study is the first, to our knowledge, to assess “hard outcomes” of MFD in SNF settings, focusing on early home discharge.
The observational data suggest an increase in timely home discharge among patients receiving MFD, despite their poorer health status, compared with those receiving conventional dialysis. If the findings are borne out by further study, the researchers conclude: “MFD in the SNF in coordination with hospital information transfer [may allow] for acceptance of [patients who are sicker] into the SNF, presumably permitting earlier hospital discharge, while also hastening SNF discharge to home” [Bellin EY, et al. On-site more frequent dialysis may hasten return home for nursing home end-stage renal disease patients. Kidney360, published online June 7, 2024. doi: 10.34067/KID.0000000000000487].
