Excellent long time survival for <scp>S</scp>wedish patients starting home‐hemodialysis with and without subsequent renal transplantations

Clyne

Segelmark

2016

Kidney Blood Press Res

Self Cite

Background/Aims: Survival for dialysis patients is poor. Earlier studies have shown better survival in home-hemodialysis (HHD). The aims of this study are to compare survival for matched patients with HHD and institutional hemodialysis (IHD) and to elucidate the effect on factors related to survival such as hyperphosphatemia, fluid overload and anemia. Methods: In this retrospective, observational study, incident patients starting HHD and IHD were matched according to sex, age, comorbidity and date of start. Survival analysis was performed both as ”intention to treat” including renal transplantation and ”on treatment” with censoring at the date of transplantation. Dialysis doses, laboratory parameters and prescriptions of medications were compared. Results: After matching, 41 pairs of patients, with HHD and IHD, were included. Survival among HHD patients was longer compared with IHD, median survival being 17.3 and 13.0 years (p=0.016), respectively. The “on treatment” analysis, also favoured HHD (p=0.015). HHD patients had lower phosphate, 1.5 mmol/L compared with 2.1 mmol/L (p<0.001) and no antihypertensives and diuretics compared with 2 for IHD patients at 6 (p=0.001) and 18 months (p=0.014). There were no differences in hemoglobin or albumin. Conclusion: HHD shows better survival compared with IHD, also after controlling for patient selection. This could be caused by better phosphate and/or fluid balance associated with higher dialysis doses.

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 78%

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Home- or Institutional Hemodialysis? - a Matched Pair-Cohort Study Comparing Survival and Some Modifiable Factors Related to Survival

Clyne

Segelmark

2016

Kidney Blood Press Res

Self Cite

“…Morbidity and mortality remain high for patients on dialysis despite improvement during the twenty-first century [1][2][3]. Most earlier studies have shown better survival for patients on home hemodialysis (HHD), compared with patients on institutional hemodialysis (IHD) or peritoneal dialysis (PD) [4][5][6][7][8][9][10][11]. We corroborated these findings in earlier studies after matching for age and comorbidity [10,12] and taking into account that patients with HHD, have a higher rate of renal transplantation compared with patients on IHD or PD.…”

Section: Introductionmentioning

confidence: 99%

Fewer hospitalizations and prolonged technique survival with Home Hemodialysis– a matched cohort study from the Swedish Renal Registry

Ivarsson²,

Almquist³

et al. 2019

Preprint

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Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower median annual admission rate and number of days in hospital. (1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

“…Morbidity and mortality remain high for patients on dialysis despite improvement during the 21st century (1)(2)(3). Most earlier studies have shown better survival for patients on home hemodialysis (HHD), compared with patients on institutional hemodialysis (IHD) or peritoneal dialysis (PD) (4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Fewer hospitalizations and prolonged technique survival with Home Hemodialysis– a matched cohort study from the Swedish Renal Registry

Ivarsson²,

Almquist³

et al. 2019

Preprint

Self Cite

Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). However, the effects of treatment modality on morbidity and health care utilization are divergent between studies. The aim of this study is to compare health care utilization between modalities. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower median annual admission rate and number of days in hospital. (1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.