Complexity of In-Hospital Admission Course in Patients on Kidney Replacement Therapy: A Comparative Analysis between Home Hemodialysis and In-Centre Hemodialysis: Experience from Saudi Arabia

Background: In patients with ESKD, in-center hemodialysis (IHD) and Home Hemodialysis (HHD) are two of the available modalities for Kidney Replacement Therapy (KRT). Patients receiving dialysis, whether in-center or at home, are at a high risk of hospitalization. We wanted to study the in-hospital course in patients undergoing these dialysis modalities. Methods: This retrospective chart review included 42 adult patients (≥18 years) with ESKD who have completed one year of KRT, either IHD (n=21) or HHD(n=21) at King Faisal Specialist Hospital and Research Centre Jeddah (KFSHRCJ) between 01 August 2022 to 31 July 2023.We studied in-hospital admission encounters in both dialysis modalities in regards to frequency of admission, Inhospital consultations, Estimated length of stay(ELOS), all cause mortality and readmission within 30 days of discharge. Results: We had a demographically comparable patient population in both groups. There were 59 admission encounters in IHD population as compared to 29 encounters in HHD. For IHD admissions, the number of subspecialities consulted was 2.37 per admission encounter with total number of consultations (n=140). In HHD admissions, the number of subspecialities consulted were 2.1 per admission with total number of consultation (n=61). The ELOS (Estimated Length of Stay) for IHD patients was 3.7 days per encounter with total hospital days (n=218) in a year follow up as compared to 4.1 days per encounter in HHD patients with total hospital days ( n=118).There was higher readmission rate in IHD with same or different etiology within 30 days of discharge(n=12) as compared to HHD (n=4). The all cause mortality of patients who completed one year on KRT was 11 in IHD group as compared to 4 in HHD group. The leading cause of mortality was cardiovascular disease in IHD and infections in HHD group. Conclusion: HHD was associated with lower events of hospitalization, less inhospital consultation burden, less cumulative ELOS, lower all cause mortality and lower rate of readmission as compared to IHD. These findings are limited by small sample size, single centre retrospective followup of one year. We need multicentre study with large sample size over longer duration of time to study the significance of outcomes in our study.