Seasonal Differences in Home Dialysis Uptake and Initiating Dialysis in the Hospital

Study Overview
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Brief Summary
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This study will investigate whether home dialysis uptake varies by the season of year. We will also investigate whether hospitalizations around the time of dialysis also vary by season of year and whether hospitalizations are associated with reduced home dialysis starts and sustained home dialysis uptake.

Official Title
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Seasonal Differences in Home Dialysis Uptake and Initiating Dialysis in the Hospital

Conditions
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Dialysis, Peritoneal Dialysis, Hospitalizations

Intervention / Treatment
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* Other: Season of Year
* Other: Hospitalized 14 days prior to dialysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Started dialysis in the USA for end-stage kidney disease from 12/1/2007-11/30/2017 No transplant or death prior to day 90 of dialysis Medicare Parts A/B as primary payer 30 days prior to starting dialysis Valid Medicare Evidence Form (Form 2728) Exclusion Criteria: As above

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients initiating dialysis for end-stage kidney disease<br>Patients whose start of dialysis is from 12/1/2007-11/30/2017. We use the following inclusion criteria: Adult (>= 18 years old) Did not die or have a transplant prior to the 90th day of dialysis Valid medical evidence form Medicare Part A/B as primary payer in the 30 days prior to initiating dialysis Initiating dialysis in the USA | Other: Season of Year<br>* We stratify patients into 4 groups based on the season of the year (between 12/1/2007-11/30/2017) Winter: December, January, February Spring: March, April, May Summer: June, July, August Fall: September, October, November<br>Other: Hospitalized 14 days prior to dialysis<br>* We further stratify patients into 3 groups based on whether they were hospitalized within 14 days prior to dialysis Group 1: No hospitalization prior to dialysis Group 2: Hospitalized within 14 days prior to dialysis for an acute infectious respiratory condition or one of the following acute cardiac conditions (arrhythmia, myocardial infarction, stroke, or fluid overload) Group 3: Hospitalized within 14 days prior to dialysis for a condition not in Group 2<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Type of dialysis modality at the start of dialysis | Whether patient started with home dialysis or in-center dialysis at the start of dialysis | Day 1 of dialysis | 
| Type of dialysis modality at the end of month 3 of dialysis | Whether patient was using home dialysis or in-center dialysis at the end of month 3 of dialysis (day 84) | End of month 3 of dialysis | 
| Type of dialysis modality at the end of month 6 of dialysis | Whether patient was using home dialysis or in-center dialysis at the end of month 6 of dialysis (day 168) | End of month 6 of dialysis | 
| Type of dialysis modality at the end of month 9 of dialysis | Whether patient was using home dialysis or in-center dialysis at the end of month 9 of dialysis (day 252) | End of month 9 of dialysis | 
| Type of dialysis modality at the end of month 12 of dialysis | Whether patient was using home dialysis or in-center dialysis at the end of month 12 of dialysis (day 336) | End of month 12 of dialysis | 
| Mortality in the first year | Whether the patient died in the first year of dialysis and the number of days the patient survived - Censored for transplantation, loss to follow-up | 1 year of dialysis |