Hemodialysis in satellite dialysis units: incidence of patient fallback to the in-center dialysis unit

Patient fallbacks occur when a patient treated in a satellite dialysis unit (SDU) must be transferred to an in-center dialysis unit. Fallbacks have an impact on the in-center dialysis unit organization. This study was carried out to estimate the incidence and risk factors of patient fallback.

Between 01/01/2006 and 31/12/2010 there were 193 patients starting dialysis in SDUs in one French region. The primary outcome was the incidence of temporary and permanent fallbacks with or without hospitalization. A survival analysis and binomial negative regression were used for the statistical analysis.

Among the 193 patients, 117 (60.6 %; 95 % confidence interval [CI]: 53.3–67.6) had at least one fallback, which occurred within a median of 249 days (interquartile range [IQR]: 71–469) after the first session in the SDU. The median number of fallbacks by subject was 1 (IQR: 0–4). The median duration of the fallback period was 4 days (IQR: 1–8) and median number of dialysis sessions during the fallback time was 1 (IQR: 1–3). Of the 494 temporary fallbacks, 210 were due to patient hospitalization, the main cause of which was cardiovascular disease. At univariate analysis, patients permanently transferred to in-center hemodialysis units were older, had more peripheral arteriopathy, cancer and arrhythmia. At multivariate analysis, peripheral arteriopathy (relative risk [RR] 2.06, 95 % CI 1.05–4.09) and the center (center 2: RR 0.42, 95 % CI 0.21–0.84; center 3: RR 2.88, 95 % CI 1.20–6.91) were significantly associated with the number of fallbacks.

Fallback is a common event in hemodialysis patients treated in SDUs. Yet, the SDU system operates well since a third of patients treated in these units are still in SDUs at 2 years of follow-up. Factors associated with patient fallback are the center and cardiovascular disease.