Nephrology News & Issues
New data shows home HD superior for patient and technique survival, hospitalizations
by Mark E. Neumann
PHILADELPHIA––There has been an assumption that home dialysis therapies offer patients a better quality of life than conventional, in-center therapy. But which home modality offers the best outcomes?
Results of a new study conducted by the Chronic Disease Research Group (CDRG) presented here at the American Society of Nephrology's Kidney Week 2014 show daily home hemodialysis (DHHD) patients have a 16% lower risk of death, 8% lower risk of hospitalization, and 38% lower risk of therapy attrition than peritoneal dialysis (PD) patients.
In a review of medication use, DHHD patients did see an increase in mean ESA dose, but saw stability in the use of phosphate binders, and saw a drop among the number of patients using anti-hypertensive medications. Mean ESA dose for PD patients was “significantly lower,” according to the researchers, as well as for in-center hemodialysis patients when compared to DHHD patients.
Using a 33-factor algorithm to match 4,460 frequent HHD patients from a registry of NxStage Medical System One users with 4,460 PD patients who received treatment between January 2007-June 2010, the results of the study showed that there was 13% lower risk of cardiovascular-related death and 20% lower risk of infection-related death with HHD therapy. Additionally, frequent HHD patients were 16% and 11% less likely to be hospitalized for cardiovascular or infection-related diagnoses, respectively.
Cumulative incidence of technique failure for DHHD vs. PD patients in the study was 9.1% vs. 17.3% at six months; 17.9% vs. 27.3% at one year; 27.5% vs. 37.5% at two years, and 31.9% vs. 44.7% at three years. “Further study is needed to identify key differences in the distribution of causes of technique failure in DHHD and PD patients and whether relative hazards of technique failure wary by dialysis provider,” CDRG researchers said.
Hospitalizations. The lower risk of hospitalizations among DHHD patients including first admissions, subsequent readmissions, admissions due to cardiovascular disease, including heart failure, admissions due to infection, and cumulative days.
Mortality. The lower risk of death was most pronounced in patients initiating home dialysis after > six months following the onset of ESRD, and after the first year of follow-up in patients initiating home dialysis within six months following ESRD onset.
"This study provides evidence that HHD is not only a viable alternative to PD, but may be a better alternative for some patients electing to perform home dialysis," said CDRG study presenter Eric Weinhandl. "Moreover, the study challenges the commonly held conception that therapy attrition is higher with HHD than with PD."