Home Dialysis Transitions in Canada During the COVID-19 Pandemic: An Interrupted Time Series Analysis
Bibliographic record
Abstract
Rationale & Objective During the COVID-19 pandemic, nephrology societies recommended transition from facility-based hemodialysis to home dialysis to minimize risks associated with COVID-19 infection. We compared transition rates from facility-based hemodialysis to home dialysis and rates and reasons for transfers from home dialysis to facility-based hemodialysis before and during the pandemic in Canada. Study Design Interrupted time-series analysis. Setting & Population Using administrative data from the Canadian Organ Replacement Register, our cohort included 31,596 and 22,607 adults with any time on hemodialysis during the pre-pandemic and pandemic study periods, respectively. Exposure Early pandemic (April 1, 2020 – September 30, 2021) versus pre-pandemic (January 1, 2016 – December 31, 2019). Outcomes Monthly rates of transitions between facility-based hemodialysis and home dialysis, reasons for transfer from home to facility. Analytical Approach Segmented linear regression and analysis of covariance. Results During the early pandemic, transitions to home dialysis rose by 0.60 per 10,000 patients/month (95% CI: 0.08,1.11; P=0.03), beyond the non-significant monthly pre-pandemic trend of 0.02 per 10,000 (95% CI: –0.10,0.13; P=0.80). Monthly transfers from home dialysis to facility-based hemodialysis per 10,000 home dialysis patients also increased during the pandemic (6.91; 95% CI: 3.42, 10.40; P<0.001) versus the pre-pandemic period (-1.78; 95% CI: -4.31,0.75; P=0.20). The rate of increase in home-to-facility transfers during the pandemic was not significantly different than facility-to-home transfers (-0.10 transfers/month; 95% CI: -1.51,1.31; P=0.89). More transfers to facility occurred for geographic/resource-related reasons during the pandemic versus pre-pandemic (5.8% vs 2.7%; p <0.0001). Limitations Inability to analyze change in trends by province and ecological bias. Conclusions Transitions from facility-based hemodialysis to home dialysis increased, suggesting kidney care programs in Canada implemented recommendations intended to decrease COVID-19-related risks in this population. Reasons for the observed increase in transfers from home to facility during the pandemic are unclear.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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 teacher head, 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".