Mortality Risk Lower with Home Hemodialysis

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Home hemodialysis (HD) is associated with better survival than conventional facility HD, a finding that supports the move toward home HD by dialysis providers, according to researchers.

Mark R. Marshall, MBChB, of Middlemore Hospital in Auckland, New Zealand, and colleagues studied 26,016 patients in the Australia and New Zealand Dialysis and Transplant Registry. Compared with patients receiving conventional facility HD, those who dialyzed using conventional home HD and frequent/extended home HD had a 49% and 47% decreased death risk after adjusting for the confounding effects of patient demographics and comorbid conditions, the researchers reported online (ahead of print) in the American Journal of Kidney Diseases. The death risk with frequent/extended facility HD was not significantly different from that of conventional facility HD.

“The observed benefit of home HD relative to facility HD was not explained by dialysis operating parameters and angioaccess,” the authors observed. “It also was less for nonwhite and non-Asian patients and those older than 75 years.”

The former finding related to ethnicity probably relates to socioeconomic status, the investigators stated. “Home HD patients tend to be employed with disposable income and adequate housing,” the authors wrote.

In addition, Dr. Marshall's group noted: “The reason for the observed lower mortality risk with home HD in our study and the literature is unclear. It is possible that our result arises from selection bias: healthier patients are selected for these modalities, treated in selected nephrology services with particular expertise.”

Another and perhaps the most plausible explanation relates to treatment adherence, they pointed out. “Home HD patients tend to have low levels of dysfunction in their social circumstances, which is associated with greater adherence to dialysis, medication, fluid restriction, and lifestyle measures.”

The researchers cited studies showing that factors such as greater adherence in general and better social support are associated with lower mortality risk in dialysis populations.

The investigators defined frequent/extended dialysis as follows: more than three dialysis sessions per week, with each session lasting four hours or more; three dialysis sessions weekly each lasting more than six hours; five dialysis sessions weekly, each lasting three hours or more; or more than five dialysis sessions weekly, each lasting two hours or more.

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