Outcomes in patients on home haemodialysis in England and Wales, 1997-2005: a comparative cohort analysis

D. Nitsch, R. Steenkamp, C. R. V. Tomson, P. Roderick, D. Ansell, M. S. MacGregor
2010 Nephrology, Dialysis and Transplantation  
Background. The UK national policy promotes expansion of home haemodialysis, but there are no recent data on characteristics and outcomes of a national home haemodialysis population. Methods. We compared incident home haemodialysis patients in England and Wales (n = 225, 1997-2005) with age-and sex-matched incident peritoneal dialysis, hospital haemodialysis and satellite haemodialysis patients with follow-up until 31 December 2006. Cox regression analyses included time-dependent changes of
more » ... -listing for transplantation (a proxy for health status), start of home haemodialysis and transplantation. Results. There was a median delay of 12 months between starting renal replacement therapy (RRT) and home haemodialysis. During that first year of RRT, > 50% of home haemodialysis patients were wait-listed for kidney transplantation; hospital haemodialysis patients had a lower rate of wait-listing over time [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.44-0.70; P < 0.001]. In crude analyses, there was a marked survival advantage of home haemodialysis patients compared with other modalities (log-rank P-value < 0.001). In adjusted analyses, being on home haemodialysis yielded a long-term survival benefit compared with peritoneal dialysis (HR 0.61, 95% CI 0.40-0.93), and a borderline advantage compared with hospital haemodialysis (HR 0.68, 95% CI 0.44-1.03). There was no evidence of an advantage compared with satellite haemodialysis (HR 0.94, 95% CI 0.65-1.37). Conclusions. Home haemodialysis patients have better survival compared with other dialysis modalities. Some of this crude survival advantage is due to selection of a healthier patient cohort as evidenced by higher transplant wait-listing rates. The advantage over peritoneal dialysis persisted after adjustment for wait-listing and transplantation over time.
doi:10.1093/ndt/gfq561 pmid:20841489 fatcat:cjff3gokpzbafhymkq5tbqsv7u