Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Improved long-term survival with home hemodialysis compared with institutional hemodialysis and peritoneal dialysis : A matched cohort study

Rydell, Helena LU ; Ivarsson, Kerstin LU ; Almquist, Martin LU ; Segelmark, Mårten LU and Clyne, Naomi LU orcid (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)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
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 &lt; 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 &gt; 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}},
}