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. 2019 Dec 30;20(1):480.
doi: 10.1186/s12882-019-1644-z.

Fewer hospitalizations and prolonged technique survival with home hemodialysis- a matched cohort study from the Swedish Renal Registry

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

Fewer hospitalizations and prolonged technique survival with home hemodialysis- a matched cohort study from the Swedish Renal Registry

Helena Rydell et al. BMC Nephrol. .

Abstract

Background: Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population.

Methods: The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD.

Results: RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower annual admission rate and number of days in hospital. (median 1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD.

Conclusions: Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

Keywords: Home hemodialysis; Hospital admission; Institutional hemodialysis; Peritoneal dialysis; Technique survival.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Time to first admission. Time to first all-cause admission during overall follow up (intention to treat) for patients with HHD (n = 152) as initial RRT compared with matched patients with IHD (n = 608; p < 0.001) and PD (n = 456; p = 0.001) as initial RRT
Fig. 2
Fig. 2
Technique survival for HHD patients and matched PD patients. Patients with HHD as initial RRT have an improved technique survival compared to patients with PD as initial RRT (p < 0.001). In this analysis censoring was performed at dates of renal transplantation, the end of study and dates of death. Only changes to other dialysis modalities were defined as events
See this image and copyright information in PMC

References

    1. Swedish Renal Registry Annual report. 2017.
    1. USRDS Annual Report. 2017.
    1. ERA-EDTA Annual Report. 2015.
    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. Weinhandl ED, Gilbertson DT, Collins AJ. Mortality, hospitalization, and technique failure in daily home hemodialysis and matched peritoneal Dialysis patients: a matched cohort study. Am J Kidney Dis. 2016;67(1):98–110. doi: 10.1053/j.ajkd.2015.07.014. - DOI - PubMed

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