Survival comparison of daily home hemodialysis vs. conventional in the nursing home setting

Abstract

Nursing home patients on dialysis are higher-acuity compared to the broader end-stage renal disease population, and historically have poor outcomes. The objective of this epidemiological study was to compare outcomes in ESRD patients in the nursing home setting treated with daily home hemodialysis versus conventional three-day-a-week hemodialysis. Health status was evaluated for 3,919 patients (n=3391 conventional, n=528 daily home dialysis; April 2007 to June 2013 for conventional; April 2011 to June 2013 for daily home hemodialysis). Analyses included monthly mortality rates, Kaplan-Meier survival analysis, and laboratory values. Results showed monthly mortality rates were consistently lower in the daily home hemodialysis population over the same time period vs. conventional dialysis care. In the incident three months of treatment, annualized monthly mortality rates were 70%, 72%, and 64% in the conventional dialysis population vs. 50%, 24%, and 17% in the daily home population. Patients treated with daily home dialysis had generally similar or higher albumin and hemoglobin values and lower ferritin values over the same time period. Patients treated with daily home hemodialysis had lower monthly mortality rates and generally improved health status compared to patients treated with conventional dialysis. The results of this study are provocative and should be evaluated in a prospective study.