ArticleJournal of nephrology2025
Home dialysis as the incident modality in patients starting dialysis in West Virginia: role of the rural outreach kidney care clinic.
Article in Journal of nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundDespite 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.
methodsThis 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.
resultsOf 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).
conclusionPatients 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.
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