Nocturnal home haemodialysis: The 17 years experience of a single Australian dialysis service.

Abstract

The Barwon Health nocturnal home haemodialysis (NHHD) program was established in 2000 as the first formal NHHD program in Australia. We aimed to assess reasons for and factors associated with program exit, and technique and patient survival rates. This retrospective audit included all patients enrolled in the NHHD program from 1st September 2000 to 31st July 2017. The primary outcome was technique failure, defined as transfer to satellite haemodialysis (HD) or to peritoneal dialysis (PD) for greater than or equal to 60 days, or death. Predictors of technique failure were identified by competing risk regression analyses. Patient and technique survival were estimated by Kaplan-Meier methods. A total of 109 patients underwent 112 periods of NHHD during the study period. Technique failure occurred in 33 patients (30%), of whom 16 were transferred to satellite HD for medical reasons, 16 died, and 1 transferred to PD due to a lack of vascular access. Median technique survival was 7.8 years (interquartile range 4.1, 11.1) and median patient survival 14.6 years (interquartile range 6.2,-). Average NHHD duration for those who transferred to satellite HD was 5.2 ± 3.6 years, and for those who died was 4.7 ± 3.8 years. Older age and diabetes were associated with technique failure. However, due to a small number of events the risk of confounding in this study was high. Nocturnal home haemodialysis has excellent long-term technique and patient outcomes. Clinicians should be aware of factors associated with poorer outcomes, to ensure that additional support can be provided to patients at greatest risk.