Outcomes of a provincial home haemodialysis programme--a two-year experience: establishing benchmarks for programme evaluation

Abstract

The province of British Columbia has the only coordinated provincial programme for home-based haemodialysis (HHD) in Canada. The centrally coordinated and locally administered programme was initiated in 2002 as a pilot project, and was firmly established with secured funding in 2004. HHD programmes have reported successful outcomes with respect to patients' well-being, haemodynamic stability and improvement of clinical and biochemical parameters in small selected groups of patients. This report describes the 2-year outcomes of a provincial programme, in which more liberal criteria for patient selection have been applied, and multiple sites have trained and managed the patients over a large geographic area. As a 'newer' modality, it is important to review outcomes objectively so as to determine the true value of this home-based programme as an alternative to other home-based therapies such as peritoneal dialysis. One hundred and five patients who completed training and commenced home therapy between April 2004 and March 2006 were followed, for a total of 163.23 patient-years (PY). The average age was 52; 71% were male and the majority (58%) were Caucasian. Mean biochemical and clinical parameters were all within provincial and national target ranges at baseline and at the time of study follow-up cessation. Overall, 34 individual patients required hospital admission and 95% of the cohort required at least one in-centre run after training was completed (0.5 hospital admissions and 11 in-centre run per PY of HHD delivered). One- and 2-year technique survivals were 81% and 61% respectively, which were 85% and 74% when censored for transplantation. We were unable to demonstrate any significant predictors of technique survival using demographic, biochemical or other variables. This is the first report of HHD programme technique survival in a large provincial cohort. The 2-year technique survival of this cohort is comparable to reports of technique survival in peritoneal dialysis. These data can be used to benchmark programmes, and to foster further research to determine factors that may improve HHD technique survival.