1. Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis
- Author
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Ercan Ok, Cenk Demirci, Gulay Asci, Kivanc Yuksel, Fatih Kircelli, Serkan Kubilay Koc, Sinan Erten, Erkan Mahsereci, Ali Rıza Odabas, Stefano Stuard, Franklin W. Maddux, Jochen G. Raimann, Peter Kotanko, Peter G. Kerr, Christopher T. Chan, Fatma Toz, Huseyin Toz, Mehmet Ozkahya, Meltem Sezis, Mumtaz Yilmaz, Mehmet Sukru Sever, Alaattin Yıldız, Sıddig Momin Adam, Mine Besler, Handan Ogunc, Mujdat Batur Canoz, Mustafa Eren, Melih Anil, Kezban Pinar Yeniay, Ismail Ozer, Pınar Ergin, Elif Arı Bakır, Habib Emre, Hüseyin Atalay, Cemal Kurt, Fatma Adam, Pinar Seymen, Numan Görgülü, Bahtisen Guven, and Mustafa Keleş
- Subjects
hemodialysis ,home hemodialysis ,hospitalization ,matched case-control study ,medication requirement ,survival ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Introduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods: We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results: The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion: These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD.
- Published
- 2023
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