Hospitalisation Risk in the Integrated Home Dialysis Model: Analysis of the Canadian Organ Replacement Register
Bibliographic record
Abstract
Background: The integrated home dialysis model proposes the initiation of dialysis with peritoneal dialysis (PD) followed by transition to home hemodialysis (HHD) after PD ends. Outcomes of integrated home dialysis versus a “direct to HHD approach” are poorly known. We aimed to compare the hospitalization risk of patients in integrated home dialysis (before, during and after transfer to HHD) with patients directly initiating HHD. Methods: We studied patients in the Canadian Organ Replacement Register who initiated PD or HHD between 2005 and 2018. A 1:1 propensity score was used to match patients transitioning from PD to HHD in less than 90 days after PD (“PD+HHD” group) to patients with HHD as the first home-dialysis modality (“HHD” group). Our outcome was all-cause hospitalization, assessed from the beginning of home dialysis (PD or HHD) until transfer to facility HD, death, end of follow-up (December 31st 2019) or kidney transplant. Hospitalizations were compared between groups with shared frailty models in three periods: before PD-HHD transition, during transition, and after transition (Fig 1).Figure 1: :Results: From 63,327 patients, 13,726 initiated PD and 745 initiated HHD. 4,420 patients transferred from PD to facility HD and 163 transferred to HHD (3.6% of transfers; median time on PD 1.9 years). Hospitalization risk was similar between groups in the period before and after the PD-HHD transition but was significantly increased during the transition period (Table). Similar trends were observed when these periods were sub-divided by year (Fig 2).Figure 2:Conclusions: Patients transitioning from PD to HHD do not have an increased hospitalization risk outside their transfer period when compared with patients who start dialysis directly in HHD. Funding: Government Support - Non-U.S. Table - Time period Hospitalization rate (PD-HHD; events/pt-year) Hospitalization rate (HHD; events/pt-year) Hazard ratio (95% CI) Before transition 0.44 0.52 0.91 (0.61-1.37) During transition 1.88 0.73 2.69 (1.25-5.82) After transition 0.73 0.79 0.83 (0.56-1.24)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".