Abstract
Home haemodialysis (HD) has been associated with improvements in clinical and non-clinical outcomes. Previous studies have shown improvements in biochemical parameters, intradialytic blood pressure control, reduction in recovery time after dialysis, reduction in frequency of adverse events including hospitalisation, and improved quality of life and survival. At the end of 2017, there were 1023 patients on home HD in Australia, accounting for 9.6% of HD patients. In comparison, satellite dialysis accounts for 51.4% of HD patients. Satellite HD requires patients to travel to the HD centre typically thrice weekly for 4-5 hours of dialysis per session. Home HD removes the need for travel while increasing dialysis hours to 5-8 hours on alternate days with less interference with other activities of living, as the majority of patients dialyse overnight. The aim of this study was to determine whether or not there were significant differences in outcomes between home and satellite HD patients in an Australian centre. Prevalent home HD patients from a tertiary centre were included as of January 2008, and incident patients were added up until June 2017. Three controls (satellite HD patients) were matched to each home HD patient on age, gender and cause of end stage kidney failure (ESKD) treated at our centre. The primary outcomes were all-cause mortality (censored for transplantation) and transplantation. Secondary outcomes were average biochemical levels (haemoglobin, corrected calcium, phosphate and parathyroid hormone), proportion of patients in each group with a haemoglobin below 100g/L and phosphate above 1.8mmol/L, and whether or not transplanted patients were alive 6 months post-transplant. 542 patients were included in the analysis with 2135 person-years of data. The incidence rate of death was 6 per 100 person-years. There were no significant between group differences in average age, gender, race, smoking status, late referral, or cause of ESKD. BMI was significantly higher in home dialysis patients – 30.2kg/m2 compared to 27.3kg/m2 (p<0.0001). There was significantly higher prevalence of cerebrovascular disease at baseline in satellite compared to home HD patients (p=0.001), but no differences in prevalence of lung disease, coronary artery disease, peripheral vascular disease, cancer, diabetes, or hepatitis C. Home dialysis patients had a significantly reduced risk of death (HR=0.28, 95% CI 0.17-0.47, p<0.001). Transplant rates were higher in home patients compared to satellite patients - 61.8% and 51.6% (p=0.03). Survival rate at 6 months post transplantation was very high in both groups – 99.5% in satellite dialysis patients and 100% in home dialysis patients. Proportion of patients with low Hb (defined as Hb < 100g/L) was not significantly different between groups (p=0.35). Proportion of patients with high phosphate (defined as phosphate > 1.80mmol/L) in satellite patients compared to home patients were 46.6% and 35.8% (p<0.05). Home HD is associated with reduced risk of mortality, increased rates of transplantation, and improved phosphate control in an Australian dialysis population. With only 9.6% of dialysis patients in Australia dialysing at home, it would be worthwhile working to improve access to home HD for Australians with ESKD.
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call