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The risk of hospitalization and modality failure with home dialysis.

Suri RS, Li L, Nesrallah GE - Kidney Int. (2015)

Bottom Line: The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67-0.79)).DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD).In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs.

View Article: PubMed Central - PubMed

Affiliation: 1] Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada [2] Division of Nephrology, Western University, London, Ontario, Canada.

ABSTRACT
While home dialysis is being promoted, there are few comparative effectiveness studies of home-based modalities to guide patient decisions. To address this, we matched 1116 daily home hemodialysis (DHD) patients by propensity scores to 2784 contemporaneous USRDS patients receiving home peritoneal dialysis (PD), and compared hospitalization rates from cardiovascular, infectious, access-related or bleeding causes (prespecified composite), and modality failure risk. We performed similar analyses for 1187 DHD patients matched to 3173 USRDS patients receiving in-center conventional hemodialysis (CHD). The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67-0.79)). DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD). In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs. CHD: 0.93 vs. 1.10/patient-year, hazard ratio 0.92 (0.85-1.00)). Cardiovascular hospitalizations were lower with DHD than with CHD (0.68 (0.61-0.77)), while infectious and access hospitalizations were higher (1.15 (1.04-1.29) and 1.25 (1.08-1.43), respectively). Significantly more PD than DHD patients switched back to in-center HD (44% vs. 15%; 3.4 (2.9-4.0)). In this prevalent cohort, home DHD was associated with fewer admissions and hospital days than PD, and a substantially lower risk of modality failure.

No MeSH data available.


Related in: MedlinePlus

Treatment time received by daily hemodialysis patients over time. No, number.
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fig1: Treatment time received by daily hemodialysis patients over time. No, number.

Mentions: Of 1386 potentially eligible DHD subjects, 1116 (81%) were matched to 2784 PD controls, and 1187 (86%) were matched to 3173 in-center CHD controls (Table 1). Distribution of baseline variables was similar between DHD and comparator groups with standardized differences of <10% for all variables (Table 2). The mean treatment time received by DHD subjects was 2.7 h (s.d.=0.6, interquartile range=2.4-2.9 h) during month 1 and 2.9 h (s.d.=0.6, interquartile range=2.5–3.4 h) by 24 months (Figure 1). Eighty-nine percent of DHD patients used low dialysate flow rates of 300 ml/min; the remaining received ⩾900 ml/min. Mean percent reduction in urea was 40% per treatment (s.d.=10, interquartile range=35–43). Of PD controls, 68% received continuous ambulatory PD, whereas 32% used a cycler.


The risk of hospitalization and modality failure with home dialysis.

Suri RS, Li L, Nesrallah GE - Kidney Int. (2015)

Treatment time received by daily hemodialysis patients over time. No, number.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526768&req=5

fig1: Treatment time received by daily hemodialysis patients over time. No, number.
Mentions: Of 1386 potentially eligible DHD subjects, 1116 (81%) were matched to 2784 PD controls, and 1187 (86%) were matched to 3173 in-center CHD controls (Table 1). Distribution of baseline variables was similar between DHD and comparator groups with standardized differences of <10% for all variables (Table 2). The mean treatment time received by DHD subjects was 2.7 h (s.d.=0.6, interquartile range=2.4-2.9 h) during month 1 and 2.9 h (s.d.=0.6, interquartile range=2.5–3.4 h) by 24 months (Figure 1). Eighty-nine percent of DHD patients used low dialysate flow rates of 300 ml/min; the remaining received ⩾900 ml/min. Mean percent reduction in urea was 40% per treatment (s.d.=10, interquartile range=35–43). Of PD controls, 68% received continuous ambulatory PD, whereas 32% used a cycler.

Bottom Line: The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67-0.79)).DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD).In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs.

View Article: PubMed Central - PubMed

Affiliation: 1] Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada [2] Division of Nephrology, Western University, London, Ontario, Canada.

ABSTRACT
While home dialysis is being promoted, there are few comparative effectiveness studies of home-based modalities to guide patient decisions. To address this, we matched 1116 daily home hemodialysis (DHD) patients by propensity scores to 2784 contemporaneous USRDS patients receiving home peritoneal dialysis (PD), and compared hospitalization rates from cardiovascular, infectious, access-related or bleeding causes (prespecified composite), and modality failure risk. We performed similar analyses for 1187 DHD patients matched to 3173 USRDS patients receiving in-center conventional hemodialysis (CHD). The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67-0.79)). DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD). In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs. CHD: 0.93 vs. 1.10/patient-year, hazard ratio 0.92 (0.85-1.00)). Cardiovascular hospitalizations were lower with DHD than with CHD (0.68 (0.61-0.77)), while infectious and access hospitalizations were higher (1.15 (1.04-1.29) and 1.25 (1.08-1.43), respectively). Significantly more PD than DHD patients switched back to in-center HD (44% vs. 15%; 3.4 (2.9-4.0)). In this prevalent cohort, home DHD was associated with fewer admissions and hospital days than PD, and a substantially lower risk of modality failure.

No MeSH data available.


Related in: MedlinePlus