The trend of hospitalization in frail home hemodialysis patients versus otherwise well in-center hemodialysis patients: Exploratory insights

Objectives: Patients undergoing hemodialysis (HD), whether in-center HD (ICHD) or home HD (HHD), face a high risk of hospitalization. This risk is further aggravated by frailty, which is highly prevalent, especially among patients undergoing HHD in our center. In this study, we intend to explore the trends of hospitalization between frail HHD patients and otherwise well ICHD patients in tertiary care settings. Material and Methods: A retrospective exploratory chart review was conducted in King Faisal Specialist Hospital and Research Center, Jeddah, between August 2022 and July 2023, on 42 adult patients who were receiving either HHD or ICHD (21 in each group). The included patients had already completed 6 months on either of the HD modalities. Patients were analyzed for frequency, etiology, and recurrent hospitalization between the two groups, with a follow-up for 1 year. Results: Both groups (HHD n = 21 vs. ICHD n = 21) were comparable in clinical and demographic parameters except for a higher frailty burden in the HHD group (Clinical Frailty Scale > 6 in 76.2% vs. 28.6%; p = 0.0048). HHD had 65% fewer admissions ( n = 29 vs. n = 59; p < 0.001); 8 (39%) patients in the HHD group had no admissions, while all patients in the ICHD group got admission over 1 year. 9.5% in HHD group had ≥3 admissions versus 52.4% in ICHD group needing ≥3 admissions (χ 2 , p < 0.001). ICHD patients exhibited higher rates of vascular access malfunction (47.6% vs. 9.5%; χ2 p = 0.015), catheter-related bloodstream infection, and acute coronary syndrome admissions (23.8% vs. 0%; Fisher’s exact p = 0.048) as compared to the HHD group. Conclusion: Frail HHD patients experienced markedly fewer, less frequent, and less recurrent hospitalizations than otherwise healthy ICHD patients. These results warrant larger, prospective multicenter trials with insight into hospitalization indices, including consultation burden, estimated length of stay, and cost-comparison regarding different dialysis modalities.