Daily Home Hemodialysis May Have Edge vs. Peritoneal Dialysis

The risk of hospitalization was 27% lower for daily home hemodialysis compared with peritoneal dialysis.
The risk of hospitalization was 27% lower for daily home hemodialysis compared with peritoneal dialysis.

Daily home hemodialysis (DHD) is associated with fewer hospital admissions and a lower risk of modality failure than peritoneal dialysis (PD), according to a new study. DHD patients spent fewer days in the hospital.

The study is the first to address the comparative clinical effectiveness of DHD compared with PD, investigators Rita S. Suri, MD, of the Centre Hospitalier de l'Université de Montréal, and colleagues noted in an online report in Kidney International.

Using prospensity scoring, the researchers matched 1,116 DHD patients to 2,784 U.S. Renal Data System (USRDS) home PD patients. They also matched 1,187 DHD patients to 3,173 USRDS patients receiving in-center conventional hemodialysis (CHD). The hospitalization rate was significantly lower with DHD than PD (0.93 vs. 1.35 hospitalizations per patient-year), which translated into a 27% decreased risk of hospitalization, the researchers reported. 

The DHD patients spent a mean 5.2 days per patient-year in the hospital compared with 9.2 days per patient year in the PD group, and a significantly higher percentage of DHD patients than PD patients remained admission-free during follow-up (52% vs. 32%). The proportion of patients who switched to back to in-center HD was significantly greater in the PD than the DHD group (44% vs. 15%).

Hospitalization rates for DHD patients and patients receiving in-center CHD do not differ significantly (0.93 vs. 1.10 admissions per patient-year). The risk of cardiovascular-related admissions, however, was 32% lower with DHD than CHD and the risk of infectious and access-related hospitalizations were 15% and 25% higher, respectively, with DHD.

The researchers concluded that their study “provides timely, highly relevant information for prevalent considering home dialysis.”

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