Thirty years of universal home dialysis in Christchurch

Abstract

Aim: To review 30 years of universal home dialysis in a single dialysis unit.

Method: Analysis for patients using home dialysis since 1969 of information from hospital visits, clinical case notes and demographic and survival data from the Australia and New Zealand Dialysis and Transplant Registry.

Results: Since 1969 treatment options at the Christchurch Nephrology Unit for patients with end-stage renal disease have been home haemodialysis (HD), renal transplantation and, since 1979, continuous ambulatory peritoneal dialysis (CAPD). No long-term, hospital-based treatment has been offered. During this time 493 patients, aged 3-82 years, began treatment. The mean training time for home HD was 79 days (range 23-268) and for home CAPD 7 days (range 1-35). The mean HD treatment time was 7 hours x 3 per week (range 10-36 hours/week). Between 1980 and 1995, less than 5% of patients took antihypertensive drugs and 73% of those aged 18-65 years were in full or part-time employment. The mean age of patients commencing treatment increased from 41.8 years in the 1970s to 50.1 years in the 1990s. The median patient survival from 1970-1997 was 7.75 years on home HD and 2.1 years on home CAPD. Median survival on dialysis fell in the 1990's as more diabetics and older patients with comorbidity started treatment.

Conclusions: Home HD allows good rehabilitation, long treatment times and good blood pressure control which may all contribute to the superior survival of home versus hospital HD. CAPD survival in Christchurch was worse than HD, but this is probably due to patient selection. A policy of universal home dialysis is still workable provided there are sufficient resources for training and support of patients in the community.