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Comparative Study
. 2019 Feb 13;20(1):52.
doi: 10.1186/s12882-019-1245-x.

Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis: a matched cohort study

Helena Rydell  1 , Kerstin Ivarsson  2 , Martin Almquist  3 , Mårten Segelmark  4 , Naomi Clyne  4
Affiliations
Comparative Study

Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis: a matched cohort study

Helena Rydell et al. BMC Nephrol. .

Abstract

Background: The survival rate for dialysis patients is poor. Previous studies have shown improved survival with home hemodialysis (HHD), but this could be due to patient selection, since HHD patients tend to be younger and healthier. The aim of the present study is to analyse the long-term effects of HHD on patient survival and on subsequent renal transplantation, compared with institutional hemodialysis (IHD) and peritoneal dialysis (PD), taking age and comorbidity into account.

Methods: Patients starting HHD as initial renal replacement therapy (RRT) were matched with patients on IHD or PD, according to gender, age, Charlson Comorbidity Index and start date of RRT, using the Swedish Renal Registry from 1991 to 2012. Survival analyses were performed as intention-to-treat (disregarding changes in RRT) and per-protocol (as on initial RRT).

Results: A total of 152 patients with HHD as initial RRT were matched with 608 IHD and 456 PD patients, respectively. Median survival was longer for HHD in intention-to-treat analyses: 18.5 years compared with 11.9 for IHD (p < 0.001) and 15.0 for PD (p = 0.002). The difference remained significant in per-protocol analyses omitting the contribution of subsequent transplantation. Patients on HHD were more likely to receive a renal transplant compared with IHD and PD, although treatment modality did not affect subsequent graft survival (p > 0.05).

Conclusion: HHD as initial RRT showed improved long-term patient survival compared with IHD and PD. This survival advantage persisted after matching and adjusting for a higher transplantation rate. Dialysis modality had no impact on subsequent graft survival.

Keywords: Home hemodialysis; Institutional hemodialysis; Peritoneal dialysis; Renal graft survival; Survival.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethical Review Board in Lund (2014/933). In this study we only used registry data. According to Swedish law Quality Registries can be used for research. Patients are informed and have a right to decline to be registered, but no additional consent is required for specific projects.

Consent for publication

Not applicable.

Competing interests

he authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Inclusion and exclusion of matched patients with HHD, IHD and PD as initial renal replacement therapy
Fig. 2
Fig. 2
Overall survival. Superior overall survival (intention-to-treat analysis) for incident patients with HHD (n = 152) as first renal replacement therapy (RRT) compared with matched patients with IHD (n = 608; p < 0.001) and PD (n = 456; p = 0.002) as first RRT. In the analyses, changes to other modalities were not considered and censoring was only performed at the end of the study
Fig. 3
Fig. 3
Survival on initial RRT. Superior survival during the first renal replacement therapy (RRT) for patients with HHD (n = 152) compared with matched patients with IHD (n = 608; p < 0.001) and PD (n = 456; p = < 0.001). In these analyses, censoring was performed at all changes to other modalities
See this image and copyright information in PMC

References

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    1. ERA-EDTA Annual report 2015. https://www.era-edta-reg.org.
    1. Swedish Renal Registry Annual Report 2016. https://www.medscinet.net/snr.
    1. Weinhandl ED, Liu J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012;23(5):895–904. doi: 10.1681/ASN.2011080761. - DOI - PMC - PubMed
    1. Saner E, Nitsch D, Descoeudres C, Frey FJ, Uehlinger DE. Outcome of home haemodialysis patients: a case-cohort study. Nephrol Dial Transplant. 2005;20(3):604–610. doi: 10.1093/ndt/gfh674. - DOI - PubMed

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