Risk of Major Adverse Cardiovascular Events in Home Dialysis Compared to In-Center Hemodialysis

Abstract

Background: Among dialysis patients, cardiovascular events are the leading cause of death. Little is known about how the frequency and type of cardiovascular events differ between various dialysis modalities. We compared risk of major adverse cardiovascular events (MACE) in patients who started continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and home hemodialysis (HD) with in-center HD patients. Methods: We included 968 patients who entered dialysis in the Helsinki-Uusimaa healthcare district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home HD and 432 on in-center HD at day 90 from the start of dialysis. MACE was defined as acute myocardial infarction, stroke, or death due to cardiovascular disease. The cumulative incidence of the first MACE was calculated. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for potential confounding factors. Results: Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6%) during the first year of follow-up. The cumulative incidence of first MACE was similar in in-center HD and CAPD patients and higher than that in APD and home HD patients. After adjustment for possible confounders, the hazard ratio (HR) of MACE was 1.22 [95% confidence intervals (CI) 0.73–2.05] for CAPD, 0.86 [95% CI 0.47–1.57] for APD and 0.67 [95% CI 0.30–1.50] for home HD compared to in-center HD. Unexpectedly, compared to in-center HD, PD associated with lower risk of MACE among females (HR 0.37, 95% CI 0.14–0.99) and higher risk among males (HR 1.80, 95% CI 1.11–2.92). Conclusions: In this cohort, the risk of MACE was comparable across in-center and home dialysis modalities. However, the result differed between males and females, which requires further research.