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Hemodialysis at Home: Better Survival in ESRD?

Home hemodialysis (HHD) may be associated with better survival compared with in-center hemodialysis (IHD) among patients with end-stage renal disease (ESRD), according to a new study presented at the American Society of Nephrology’s Kidney Week 2018.
The study drew data from the United States Renal Data System. Patients who initiated HHD (n = 1773) underwent dialysis with the NxStage System One between January 1, 2006, and December 31, 2012, and within 3 months post-initiation. Patients who initiated IHD (n = 555,366) were treated in a dialysis facility 45 days post-initiation.
Follow-up began on the first day of at-home treatment for HHD patients and at day 45 for IHD patients and lasted until death or for a maximum of 1 year. Adjusted hazard ratios (AHRs) for HHD vs IHD were estimated using Cox regression.
Following adjustment for age, race, primary cause of ESRD, and other factors, the results of the study showed that survival after 1 year of follow-up was 91.7% in HHD patients compared with 81.4% in IHD patients.
AHRs for death were:

  • 0.77 for HHD vs IHD
  • 0.56 for ages 20 to 44 years
  • 0.74 for ages 45 to 64 years
  • 0.89 for age 65 years or older 
  • 0.68 for a glomerular filtration rate (GFR) of less than 10 mL/min/1.73 m2
  • 0.80 for a GFR of at least 10 mL/min/1.73 m2

REFERENCE:
Weinhandl ED, Kubisiak K, Ray D, Collins AJ. Relative survival among incident patients on home versus in-center hemodialysis. Paper presented at: American Society of Nephrology Kidney Week 2018; October 23-28, 2018; San Diego, CA.

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