Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis : A matched cohort study
(2019) In BMC Nephrology 20(1).- Abstract
Background: The survival rate for dialysis patients is poor. Previous studies have shown improved survival with home hemodialysis (HHD), but this could be due to patient selection, since HHD patients tend to be younger and healthier. The aim of the present study is to analyse the long-term effects of HHD on patient survival and on subsequent renal transplantation, compared with institutional hemodialysis (IHD) and peritoneal dialysis (PD), taking age and comorbidity into account. Methods: Patients starting HHD as initial renal replacement therapy (RRT) were matched with patients on IHD or PD, according to gender, age, Charlson Comorbidity Index and start date of RRT, using the Swedish Renal Registry from 1991 to 2012. Survival analyses... (More)
Background: The survival rate for dialysis patients is poor. Previous studies have shown improved survival with home hemodialysis (HHD), but this could be due to patient selection, since HHD patients tend to be younger and healthier. The aim of the present study is to analyse the long-term effects of HHD on patient survival and on subsequent renal transplantation, compared with institutional hemodialysis (IHD) and peritoneal dialysis (PD), taking age and comorbidity into account. Methods: Patients starting HHD as initial renal replacement therapy (RRT) were matched with patients on IHD or PD, according to gender, age, Charlson Comorbidity Index and start date of RRT, using the Swedish Renal Registry from 1991 to 2012. Survival analyses were performed as intention-to-treat (disregarding changes in RRT) and per-protocol (as on initial RRT). Results: A total of 152 patients with HHD as initial RRT were matched with 608 IHD and 456 PD patients, respectively. Median survival was longer for HHD in intention-to-treat analyses: 18.5 years compared with 11.9 for IHD (p < 0.001) and 15.0 for PD (p = 0.002). The difference remained significant in per-protocol analyses omitting the contribution of subsequent transplantation. Patients on HHD were more likely to receive a renal transplant compared with IHD and PD, although treatment modality did not affect subsequent graft survival (p > 0.05). Conclusion: HHD as initial RRT showed improved long-term patient survival compared with IHD and PD. This survival advantage persisted after matching and adjusting for a higher transplantation rate. Dialysis modality had no impact on subsequent graft survival.
(Less)
- author
- Rydell, Helena
LU
; Ivarsson, Kerstin
LU
; Almquist, Martin
LU
; Segelmark, Mårten
LU
and Clyne, Naomi
LU
- organization
- publishing date
- 2019-02-13
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Home hemodialysis, Institutional hemodialysis, Peritoneal dialysis, Renal graft survival, Survival
- in
- BMC Nephrology
- volume
- 20
- issue
- 1
- article number
- 52
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85061475167
- pmid:30760251
- ISSN
- 1471-2369
- DOI
- 10.1186/s12882-019-1245-x
- language
- English
- LU publication?
- yes
- id
- 8f6194d1-9356-44ba-b7e8-750a612762e5
- date added to LUP
- 2019-02-21 08:53:59
- date last changed
- 2024-06-11 05:24:46
@article{8f6194d1-9356-44ba-b7e8-750a612762e5, abstract = {{<p>Background: The survival rate for dialysis patients is poor. Previous studies have shown improved survival with home hemodialysis (HHD), but this could be due to patient selection, since HHD patients tend to be younger and healthier. The aim of the present study is to analyse the long-term effects of HHD on patient survival and on subsequent renal transplantation, compared with institutional hemodialysis (IHD) and peritoneal dialysis (PD), taking age and comorbidity into account. Methods: Patients starting HHD as initial renal replacement therapy (RRT) were matched with patients on IHD or PD, according to gender, age, Charlson Comorbidity Index and start date of RRT, using the Swedish Renal Registry from 1991 to 2012. Survival analyses were performed as intention-to-treat (disregarding changes in RRT) and per-protocol (as on initial RRT). Results: A total of 152 patients with HHD as initial RRT were matched with 608 IHD and 456 PD patients, respectively. Median survival was longer for HHD in intention-to-treat analyses: 18.5 years compared with 11.9 for IHD (p < 0.001) and 15.0 for PD (p = 0.002). The difference remained significant in per-protocol analyses omitting the contribution of subsequent transplantation. Patients on HHD were more likely to receive a renal transplant compared with IHD and PD, although treatment modality did not affect subsequent graft survival (p > 0.05). Conclusion: HHD as initial RRT showed improved long-term patient survival compared with IHD and PD. This survival advantage persisted after matching and adjusting for a higher transplantation rate. Dialysis modality had no impact on subsequent graft survival.</p>}}, author = {{Rydell, Helena and Ivarsson, Kerstin and Almquist, Martin and Segelmark, Mårten and Clyne, Naomi}}, issn = {{1471-2369}}, keywords = {{Home hemodialysis; Institutional hemodialysis; Peritoneal dialysis; Renal graft survival; Survival}}, language = {{eng}}, month = {{02}}, number = {{1}}, publisher = {{BioMed Central (BMC)}}, series = {{BMC Nephrology}}, title = {{Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis : A matched cohort study}}, url = {{http://dx.doi.org/10.1186/s12882-019-1245-x}}, doi = {{10.1186/s12882-019-1245-x}}, volume = {{20}}, year = {{2019}}, }