Home Hemodialysis May Offer Better Survival
A study of new dialysis patients showed that home hemodialysis was associated with a 23% decreased risk of death at 1 year compared with in-center hemodialysis.
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SAN DIEGO—More frequent home hemodialysis (HHD) is associated with better first-year survival odds than in-center hemodialysis (IHD) among patients new to dialysis, new data presented at the American Society of Nephrology's Kidney Week 2018 meeting suggest.
After 1 year of follow-up, the survival rate was significantly higher among patients on HHD compared with those on IHD (91.7% vs 81.4%), Eric D. Weinhandl, PhD, MS, and colleagues at NxStage Medical, Inc., of Lawrence, Massachusetts, reported.
In adjusted analyses, HHD was associated with a significant 23% decreased risk of death compared with IHD. The survival advantage conferred by HHD was stronger among younger patients and decreases with age. Among patients aged 20–44 years, 45–64 years, and 65 years or older, HHD was associated with a 44%, 26%, and 11% decreased risk of death compared with IHD.
Compared with IHD, HHD was associated with a significant 32% and 20% decreased risk of death among patients with an estimated glomerular filtration rate (in mL/min/1.73 m2) less than 10 and 10 or higher, respectively.
The study included 1773 HHD and 555,366 IHD patients. HHD patients were younger than IHD patients (mean age 55.3 vs 60.3 years) and had higher proportions of white patients (81.3% vs 62.7%) and male patients (71.1% vs 57.0%), Dr Weinhandl's team reported. HHD patients were less likely to be on Medicaid (9.5% vs 28.3%) and less likely to have heart failure (15.8% vs 31.3%).
Investigators followed up HHD patients from the day of the first at-home treatment and IHD patients from the 45th day after dialysis initiation. They followed up patients until death, but for a maximum of 1 year.
“There are three key factors that distinguish the HHD population in this study: greater likelihood of pre-ESRD nephrology care, dialysis treatment in the home setting, and more frequent hemodialysis—4 to 6 treatments per week, Dr Weinhandl told Renal & Urology News. “More frequent hemodialysis, in particular, has been shown to improve multiple parameters of cardiovascular health.”
The relatively large survival advantage in young adult patients merits more research, he said, noting that a large survey of German dialysis patients found that life expectancy is relatively highly valued by young adult and middle-aged dialysis patients.
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Weinhandl ED, Kubisiak K, Ray D, Collins AJ. Relative survival among incidence patients on home versus in-center hemodialysis. Presented at the American Society of Nephrology's 2018 Kidney Week meeting in San Diego, Oct. 23-28. Abstract FR-OR001.