The impact of the COVID-19 pandemic on home dialysis modality use in Canada

Background: During the COVID-19 pandemic, nephrology societies recommended that individuals receiving facility-based hemodialysis transition to home modalities where possible. We aimed to understand if more people transitioned from facility-based hemodialysis to home dialysis modalities in Canada during the COVID-19 pandemic compared to historical trends. We also compared home dialysis failure (transition to facility-based hemodialysis) rates, reasons for failure on home dialysis, and risk factors for failure on home dialysis. Methods: Using administrative data from the Canadian Organ Replacement Registry (CORR), we performed an interrupted time-series analysis comparing monthly trends in transition to and failures on home dialysis during the pre-pandemic period (Jan. 1, 2016 – Dec. 31, 2019) to the pandemic period (Apr. 1, 2020 – Sept. 30, 2021). All individuals who spent any time on hemodialysis during the study period were included in the study cohort. Transitions and failures were each defined as moves of 30 days or greater. Logistic regression models were used to examine predictors of home dialysis failures between time periods. Results: 31,596 and 22,607 individuals were prevalent on facility-based hemodialysis during the pre-pandemic and pandemic periods, respectively. Transitions to home dialysis increased during the pandemic (trend change = 0.00006, p=0.03). Home dialysis failures within our cohort increased (trend change = 0.000357, p=0.045) but facility-based initiations did not change during the pandemic as compared to pre-pandemic. In our cohort, there were more home dialysis failures due to peritonitis (9.2% vs 7.3%; p = 0.0423) and resource-related reasons (5.8% vs 2.7%; p <0.0001), and fewer failures due to dialysis recipient/family burnout (4.3% vs 5.9%; p=0.0307) during the pandemic period. Conclusion: Transitions to home dialysis increased in response to COVID-19 related risks. Whether the increase in home dialysis failures was attributable to exc