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. 2020 Jan 9;5(3):296-306.
doi: 10.1016/j.ekir.2019.12.019. eCollection 2020 Mar.

Intensive Home Hemodialysis Survival Comparable to Deceased Donor Kidney Transplantation

Angie G Nishio-Lucar  1 , Subhasish Bose  1   2 , Genevieve Lyons  1 , Kwabena T Awuah  1   2 , Jennie Z Ma  1 , Robert S Lockridge Jr  1   2
Affiliations

Intensive Home Hemodialysis Survival Comparable to Deceased Donor Kidney Transplantation

Angie G Nishio-Lucar et al. Kidney Int Rep. .

Abstract

Introduction: Kidney transplantation (KT) remains the treatment of choice for end-stage kidney disease (ESKD), but access to transplantation is limited by a disparity between supply and demand for suitable organs. This organ shortfall has resulted in the use of a wider range of donor kidneys and, in parallel, a reexamination of potential alternative renal replacement therapies. Previous studies comparing Canadian intensive home hemodialysis (IHHD) with deceased donor (DD) KT in the United States reported similar survival, suggesting IHHD might be a plausible alternative.

Methods: Using data from the Scientific Registry of Transplant Recipients and an experienced US-based IHHD program in Lynchburg, VA, we retrospectively compared mortality outcomes of a cohort of IHHD patients with transplant recipients within the same geographic region between October 1997 and June 2014.

Results: We identified 3073 transplant recipients and 116 IHHD patients. Living donor KT (n = 1212) had the highest survival and 47% reduction in risk of death compared with IHHD (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34-0.83). Survival of IHHD patients did not statistically differ from that of DD transplant recipients (n = 1834) in adjusted analyses (HR: 0.96; 95% CI: 0.62-1.48) or when exclusively compared with marginal (Kidney Donor Profile Index >85%) transplant recipients (HR: 1.35; 95% CI: 0.84-2.16).

Conclusion: Our study showed comparable overall survival between IHHD and DD KT. For appropriate patients, IHHD could serve as bridging therapy to transplant and a tenable long-term renal replacement therapy.

Keywords: KDPI; intensive home hemodialysis; kidney transplant; survival.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Survival by treatment modality. Graph represents the overall survival for living donor (LD) kidney transplant recipients, deceased donor (DD) kidney transplant recipients, and intensive home hemodialysis patients (IHHD). The overall survival differed across modalities (P < 0.001, log-rank test).
Figure 2
Figure 2
Survival of deceased donor (DD) kidney transplant recipients by organ quality versus intensive home hemodialysis (IHHD). Graph represents the overall survival among those who received DD kidney transplants stratified by Kidney Donor Profile Index (KDPI) category (KDPI <20%, 20%–85%, >85%) compared with IHHD patients. The overall survival differed across modalities (P < 0.002, log-rank test). However, there was no significant difference when comparing high KDPI recipients with IHHD (P = 0.2168).
Figure 3
Figure 3
Survival by treatment modality for patients starting on or before September 30, 2004. Graph represents the overall survival for living donor (LD) kidney transplant recipients, deceased donor (DD) kidney transplant recipients, and intensive home hemodialysis patients (IHHD) starting treatment on or before September 30, 2004. The overall survival differed across modalities (P < 0.001, log-rank test).
Figure 4
Figure 4
Survival by treatment modality for patients starting after October 1, 2004. Graph represents the overall survival for living donor (LD) kidney transplant recipients, deceased donor (DD) kidney transplant recipients, and intensive home hemodialysis patients (IHHD) starting treatment after October 1, 2004. The overall survival differed across modalities (P < 0.001, log-rank test). Compared with the previous era, survival was better across all treatment modalities.
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References

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