Severe Adverse Technical Events Rare in Home Hemodialysis

Study reveals a rate of 0.038 such events per 1,000 dialysis treatments.
Study reveals a rate of 0.038 such events per 1,000 dialysis treatments.

Serious adverse technical events are rare among patients on home hemodialysis (HHD), Canadian investigators concluded.

Karthik K.  Tennankore, of Dalhousie University/Capital Health, Halifax, Nova Scotia, and colleagues studied 202 HHD patients with a total follow-up of 757 patient-years. The patients underwent a median of 5 dialysis sessions per week and 8 hours per session. The researchers identified 22 first adverse events and 7 recurrent events. 

Adverse event (AE) rates were 0.049 per arteriovenous fistula access-year, 0.015 per artiovenous graft access-year, and 0.022 per dialysis catheter access-year, the investigators reported online ahead of print in the American Journal of Kidney Diseases. AE rates per 1,000 diaysis treatments were 0.208, 0.068, and 0.087 for arteriovenous fistula, arteriovenous graft, and dialysis catheter access, respectively.

Most AEs were related to needle dislodgement (18 events) or air embolism (6 events). In addition, 8 AEs resulted in emergency department visits and 5 required hospitalization. The rate of severe AEs was 0.009 per patient-year of HHD and 0.038 per 1,000 dialysis treatments.

Furthermore, of the 202 patients, 30 died, with 4 deaths occurring at home. None of the deaths was clearly related to technical errors.

Dr. Tennankore's team concluded that their report “re-emphasizes that the overall rate of procedure-related adverse events in HHD is low, and the risk of recurrent events is even lower. A systematic approach to retraining patients after an adverse event is feasible but may not necessarily eliminate a recurrence.”

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