Introduction: As interest in home dialysis as an initial dialysis modality grows, it remains unclear how the different home dialysis modalities may impact hospitalization outcomes, or how this relationship may change depending on patient sex and race.

Methods: We compared all-cause hospitalization rates and days in hospital between incident peritoneal dialysis (PD, n = 14,643) and home hemodialysis (HHD patients, n = 875) between January 2005 and December 2018 (last follow-up was in July 2020) using a nationally representative cohort of incident dialysis patients.

Results: The overall hospitalization rate was 0.82 hospitalization events per patient-year. Compared with those initiated on PD, HHD patients had a lower hospitalization rate (incident rate ratio [IRR] = 0.78, 95% confidence interval [CI] 0.71-0.85), and spent fewer days in hospital (IRR = 0.68, 95% CI: 0.59-0.78). This was more pronounced in more contemporary cohorts and for males. The protective effect of HHD was stronger for Black patients. When hospitalizations were analyzed by cause, the protective effect of HHD was stronger for infection-related admissions, with Black patients seeing the largest benefit.

Conclusion: The type of home modality at dialysis initiation is associated with differences in hospitalization outcomes, an association that is stronger in selected racial groups and sexes. While exploratory in nature, our work highlights the importance of further study on the differential impact of PD and HHD on hospitalization outcomes so that patients incident to dialysis may make an informed decision.

Keywords: home dialysis; hospitalization; race.

© 2025 International Society of Nephrology. Published by Elsevier Inc.

简介：

随着人们对家庭透析作为初始透析方式的兴趣日益增加，不同家庭透析模式如何影响住院结果仍不清楚，或者这种关系是否会因患者性别和种族的不同而改变也尚不明确。

方法：

我们使用一个具有全国代表性的新发透析患者的队列，在2005年1月至2018年12月期间比较了腹膜透析（PD，n = 14,643）和家庭血液透析（HHD患者，n = 875）的全因住院率和住院天数。（最后一次随访时间为2020年7月）

结果：

总体住院率为每年每名患者0.82次住院事件。与起始使用腹膜透析的患者相比，家庭血液透析（HHD）患者的住院率较低（发生率比[IRR] = 0.78, 95%置信区间 [CI] 为 0.71-0.85），且在医院停留的时间更短（IRR = 0.68，95% CI：0.59-0.78）。这种差异在较为现代的队列中和男性患者中表现得更为明显。对于黑人患者来说，HHD的保护作用更强。当按住院原因分析时，HHD对感染相关入院的保护作用更显著，尤其是黑人患者受益最大。

结论：

初始透析采用的家庭模式类型与住院结果的不同有关，这种关联在特定种族和性别群体中更为强烈。尽管本研究具有探索性质，但我们强调了进一步探讨PD和HHD对住院结果不同影响的重要性，以便使新发透析的患者能够做出知情决策。

关键词：

家庭透析；住院；种族。