International comparison of home dialysis uptake: a multi-registry analysis from the INTEGRATED Research Group.

BACKGROUND: Despite advantages, home dialysis remains underutilized globally, with significant international variability. This study aims to analyse the pattern and uptake of home dialysis within the first year of dialysis across populations in different countries with similar access to kidney replacement therapy (KRT). METHODS: This retrospective observational study utilized data from multiple national registries: ANZDATA (Australia-New Zealand), CORR (Canada), REIN (France), and UKRR (UK). We included adults over 18 starting dialysis between 1 January 2008 and 31 December 2018. The primary outcome was home dialysis initiation within the first year, visualized using cumulative incidences. Adjusted associations between patient characteristics and home dialysis initiation were analysed using clustered Cox regressions. RESULTS: The study included 30 370 patients from ANZDATA, 50 682 from CORR, 103 962 from REIN, and 72 397 from UKRR. Home dialysis uptake at 12 months ranged from 41% (ANZDATA) to 13% (REIN). Transplant rates at 12 months varied from 1.1% (New Zealand) to 3.6% (UK), while 1-year mortality ranged from 5.5% (New Zealand) to 14% (France and Canada). Median age at dialysis initiation ranged from 59 years (New Zealand) to 71 years (France). Increased age was associated with a lower probability of home dialysis. CONCLUSIONS: This study highlights international differences in use of home dialysis within the first year of KRT. Patterns of conversion from facility haemodialysis to home dialysis were also different, underscoring the potential importance of healthcare systems and cultural factors within countries.