Mortality, Hospitalization, and Technique Failure in Daily Home Hemodialysis and Matched Peritoneal Dialysis Patients: A Matched Cohort Study

Abstract

Background: Use of home dialysis is growing in the United States, but few direct comparisons of major clinical outcomes on daily home hemodialysis (HHD) versus peritoneal dialysis (PD) exist.

Study design: Matched cohort study.

Setting & participants: We matched 4,201 new HHD patients in 2007 to 2010 with 4,201 new PD patients from the US Renal Data System database.

Predictor: Daily HHD versus PD.

Outcomes: Relative mortality, hospitalization, and technique failure.

Results: Mean time from end-stage renal disease onset to home dialysis therapy initiation was 44.6 months for HHD and 44.3 months for PD patients. In intention-to-treat analysis, HHD was associated with 20% lower risk for all-cause mortality (HR, 0.80; 95% CI, 0.73-0.87), 8% lower risk for all-cause hospitalization (HR, 0.92; 95% CI, 0.89-0.95), and 37% lower risk for technique failure (HR, 0.63; 95% CI, 0.58-0.68), all relative to PD. In the subset of 1,368 patients who initiated home dialysis therapy within 6 months of end-stage renal disease onset, HHD was associated with similar risk for all-cause mortality (HR, 0.95; 95% CI, 0.80-1.13), similar risk for all-cause hospitalization (HR, 0.96; 95% CI, 0.88-1.05), and 30% lower risk for technique failure (HR, 0.70; 95% CI, 0.60-0.82). Regarding hospitalization, risk comparisons favored HHD for cardiovascular disease and dialysis access infection and PD for bloodstream infection.

Limitations: Matching unlikely to reduce confounding attributable to unmeasured factors, including residual kidney function; lack of data regarding dialysis frequency, duration, and dose in daily HHD patients and frequency and solution in PD patients; diagnosis codes used to classify admissions.

Conclusions: These data suggest that relative to PD, daily HHD is associated with decreased mortality, hospitalization, and technique failure. However, risks for mortality and hospitalization were similar with these modalities in new dialysis patients. The interaction between modality and end-stage renal disease duration at home dialysis therapy initiation should be investigated further.

Keywords: Daily home hemodialysis (HHD); US Renal Data System (USRDS); chronic kidney disease (CKD); dialysis modality; end-stage renal disease (ESRD); home dialysis; hospitalization; mortality; outcomes; peritoneal dialysis (PD); self-care dialysis; technique failure.