The Influence of Renal Centre and Patient Sociodemographic Factors on Home Haemodialysis Prevalence in the UK.
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).


CONCLUSIONS
"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.
Department of Nephrology, Central Manchester Hospitals NHS Trust, Manchester, UK.
Anuradha
A
Jayanti
Philip
P
Foden
Alasdair
A
Rae
Julie
J
Morris
Paul
P
Brenchley
Sandip
S
Mitra
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006437:Hemodialysis, Home / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
Demographics; Home haemodialysis; Self-care haemodialysis; Socioeconomic status