Introduction: Compared to traditional in-center hemodialysis (HD), in-center nocturnal dialysis (INHD) is characterized by longer sessions and nighttime administration, which may lead to better outcomes for some patients. Given the importance of patient choice in the decision to initiate INHD, we explored associations between patients' psychosocial characteristics and their receipt of INHD.
Methods: Among hemodialysis patients at a medium-sized dialysis organization, we identified INHD patients as those for whom ≥80% of dialysis sessions were INHD sessions-starting at 6:30 pm or later and lasting ≥5 hours-over the 3 months (≥20 sessions total) after their first INHD session. We extracted dialysis session data from electronic medical records and psychosocial data from social worker assessments. We tested associations of patients' psychosocial characteristics-as well as demographic and clinical characteristics-with INHD receipt among all hemodialysis patients (INHD and HD) in bivariate analyses and multivariable logistic regression models.
Findings: Among 759 patients with complete data, we identified 47 (6.2%) as INHD patients. On average, these patients were more likely than HD patients to be employed (full-time 10.6% vs. 5.2%; part-time 17.0% vs. 4.2%; P < 0.001), and they were significantly less likely to require ambulatory assistance (14.9% vs. 39.6%, P < 0.001). In multivariable regressions, we found that part-time employment (versus being unemployed) was associated with a 7.1 percentage-point higher likelihood of being an INHD patient (P = 0.01), and the negative association with ambulatory assistance needs approached statistical significance (P = 0.056). No other psychosocial factors included in this main regression analysis were statistically significantly associated with INHD patient status.
Discussion: Researchers comparing the outcomes of patients undergoing INHD versus other treatment modalities will need to account for differences in employment status-and other factors like requiring ambulatory assistance and age which may predict the ability to work-between INHD users and comparison patients to avoid bias in estimates.
Keywords: hemodialysis delivery systems; modality selection; nocturnal dialysis; psychosocial characteristics.
© 2019 International Society for Hemodialysis.