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. 2023 Sep 15;8(12):2603-2615.
doi: 10.1016/j.ekir.2023.09.007. eCollection 2023 Dec.

Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis

Ercan Ok  1 , Cenk Demirci  2 , Gulay Asci  1 , Kivanc Yuksel  1 , Fatih Kircelli  3 , Serkan Kubilay Koc  4 , Sinan Erten  2 , Erkan Mahsereci  5 , Ali Rıza Odabas  6 , Stefano Stuard  3 , Franklin W Maddux  7 , Jochen G Raimann  8 , Peter Kotanko  8 , Peter G Kerr  9 , Christopher T Chan  10 ; Turkish Home Hemodialysis Initiative
Collaborators, Affiliations

Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis

Ercan Ok et al. Kidney Int Rep. .

Abstract

Introduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up.

Methods: We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters.

Results: The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement.

Conclusion: These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD.

Keywords: hemodialysis; home hemodialysis; hospitalization; matched case-control study; medication requirement; survival.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Flow chart of the study. FMC, Fresenius Medical Care; HD, hemodialysis; HHD, home hemodialysis; ICHD, in-center conventional HD.
Figure 2
Figure 2
Kaplan Meier survival analyses in the HHD and the ICHD groups. (a) Intention-to-treat; and (b) as-treated. HHD, home hemodialysis; ICHD, in-center conventional HD.
Figure 3
Figure 3
Technique survival analyses in the HHD group. (a) Death and transplantation-censored technique survival. (b) Composite technique survival. HD, hemodialysis; HHD, home hemodialysis.
Figure 4
Figure 4
Forest plot (subgroup analyses). BMI, body mass index; ESRD, end-stage renal disease; HD, hemodialysis.
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