Patient and Center Factors in Home Dialysis Therapy Uptake: Analysis of a UK Renal Registry Cohort and a National Dialysis Center Survey

Some patients are less likely to use home dialysis, possibly due to both patient characteristics and how dialysis centers operate. We studied over 32,000 patients who began kidney replacement therapy between 2015 and 2019, linking national patient data with a 2022 survey of English dialysis centers. Using advanced statistical methods, we uncovered direct and indirect links between patient and center factors and home therapy use. Patients were more likely to use home dialysis if their center offered supportive practices like assisted dialysis, staff-led improvement projects, or home dialysis educational roadshows. Notably, centers serving diverse populations were more likely to implement such practices. This study highlights how center practices may contribute to improving and reducing disparities in access to home therapy.