In-Hospital Clinical Course of Frail Home Haemodialysis Patients vs. Otherwise Well In-Centre Haemodialysis Patients: A Tertiary Care Experience from Saudi Arabia

Abstract

Background : Patients undergoing haemodialysis, whether in-centre or at home, face a high risk of hospitalisation. At our centre, HHD is offered to patients with a high frailty index, multiple comorbidities, and need for assisted mobilisation. This study aimed to compare the in-hospital clinical course of frail patients receiving HHD with otherwise well ICHD patients. Materials and Methods: This retrospective chart review included 42 adult patients (aged ≥ 18 years), with 21 patients in each group: ICHD (n = 21) and HHD (n = 21); chart review was done from 1 August 2022 to 31 July 2023. The studied outcomes between the two groups included hospital admissions, in-hospital consultations, Estimated Length Of Stay (ELOS), readmission within 30 days of discharge, and Emergency Medical Service (EMS) presentations. Results: Of 88 hospital admissions, 67% (n = 59) were noted in the ICHD group and 33% (n = 29) in the HHD group (p = 0.0014). Inpatient consultations totaled 207, with 65% (n = 135) for ICHD and 35% (n = 72) for HHD (p < 0.001). Hospital stay duration (n = 336) was 65% (n = 218 days) for ICHD and 35% (n = 118 days) for HHD (p = 0.0000). Of the readmissions (n = 10), 80% (n = 8) occurred in the ICHD group and 20% (n = 2) in the HHD group (p = 0.06), indicating marginal significance. We observed EMS visits (n = 41), with 78% (n = 32) for ICHD and 22% (n = 9) for HHD (p = 0.0003). Conclusion: Despite having a higher frailty index, HHD patients demonstrated more favorable clinical outcomes across studied parameters. A prospective multicenter study with a larger cohort and extended follow-up is required to further validate these findings.