Comparative Effectiveness of Home Dialysis Therapies: A Matched Cohort Study

Abstract

BackgroundHome dialysis is being increasingly promoted among patients with end-stage renal disease, but the comparative effectiveness of home hemodialysis and peritoneal dialysis is unknown.ObjectiveTo determine whether patients receiving home daily hemodialysis have reduced mortality risk compared with matched patients receiving home peritoneal dialysis.DesignThis study is an observational, propensity-matched, new-user cohort study.SettingLinked electronic data were from the United States Renal Data System (USRDS) and a large dialysis provider’s database.PatientsThe patients were adults receiving in-center hemodialysis in the USA between 2004 and 2011 and registered in the USRDS.MeasurementsBaseline comorbidities, demographics, and outcomes for both groups were ascertained from the United States Renal Data System.MethodsWe identified 3142 consecutive adult patients initiating home daily hemodialysis (≥5 days/week for ≥1.5 h/day) and matched 2688 of them by propensity score to 2688 contemporaneous US patients initiating home peritoneal dialysis. We used Cox regression to compare all-cause mortality between groups.ResultsAfter matching, the two groups were well balanced on all baseline characteristics. Mean age was 51 years, 66 % were male, 72 % were white, and 29 % had diabetes. During 10,221 patient-years of follow-up, 1493/5336 patients died. There were significantly fewer deaths among patients receiving home daily hemodialysis than those receiving peritoneal dialysis (12.7 vs 16.7 deaths per 100 patient-years, respectively; hazard ratio (HR) 0.75; 95 % CI 0.68–0.82; p < 0.001). Similar results were noted with several different analytic methods and for all pre-specified subgroups.LimitationsWe cannot exclude residual confounding in this observational study.ConclusionsHome daily hemodialysis was associated with lower mortality risk than home peritoneal dialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40697-016-0105-x) contains supplementary material, which is available to authorized users.

Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review

“…The total numbers of diabetic patients included were 50,298 receiving PD and 71,532 receiving HD. Eight studies were from Asia [10,11,14,16,18,19,21,23], three were from Australia and New Zealand [15,20,22], three were from Europe [17,24,25], one was from North America [13], and one was from South Africa [12]. Several studies were based on the same registry or cohort databases, such [15,20,22], the Korean Health Insurance Review and Assessment Service (HIRA) database [10,19,21,23], and the National Health Insurance Research Database (NHIRD) of Taiwan [11,16].…”

When is more frequent hemodialysis beneficial?

“…56,[62][63][64][65] These matched analyses found frequent short HD was associated with reduced mortality risk compared to in-center three times weekly HD (Table 2), 56 as well as compared to home peritoneal dialysis (HR 0.75-0.80; 95% CI 0.68-0.87). 63,65 The authors provided the comparison of home frequent HD to home peritoneal dialysis to help reduce potential confounding associated with patients' ability to dialyze at home. Interestingly, frequent short HD was associated with reduced hospitalizations compared to peritoneal dialysis (HR 0.73; 95% CI 0.67-0.79), 62 but not compared to in-center three times weekly HD (0.92; 95% CI 0.85-1.00).…”

“…We found five papers describing mortality, hospitalizations, and modality failure on overlapping cohorts who received home frequent HD using this new device . These matched analyses found frequent short HD was associated with reduced mortality risk compared to in‐center three times weekly HD (Table ), as well as compared to home peritoneal dialysis (HR 0.75‐0.80; 95% CI 0.68‐0.87) . The authors provided the comparison of home frequent HD to home peritoneal dialysis to help reduce potential confounding associated with patients' ability to dialyze at home.…”

On‐line hemodiafiltration at home

“…1 The ESHOL study showed better cardiovascular and total survival in a group of patients receiving OL-HDF than in patients undergoing high-flux hemodialysis. [3][4][5][6][7][8][9] Home hemodialysis facilitates frequent therapy. Conversely, frequent hemodialysis has also improved survival and quality of life.…”

“…Conversely, frequent hemodialysis has also improved survival and quality of life. [3][4][5][6][7][8][9] Home hemodialysis facilitates frequent therapy. Therefore, we believe that adding convective therapies to home hemodialysis could improve treatment.…”