Outcomes of integrated home dialysis care: A multi-centre registry study.

Introduction and Aims: The 'Integrated home dialysis' model involving initiation of peritoneal dialysis (PD) first followed by home hemodialysis (HHD) has previously been proposed as an optimal form of dialysis that maximises the advantages of both modalities. While this model has great potential, its clinical outcomes, especially compared to direct HHD initiation, remain uncertain. Hence, the aim of this study was to evaluate survival in patients treated with PD and subsequently HHD, compared to treatment with a single home dialysis modality. Method(s): This study included all incident home dialysis patients, defined as PD or HHD in the first 90 days after renal replacement therapy initiation, in Australia and New Zealand between 2000 and 2012. Propensity score matching was performed to evaluate patients initially treated with PD followed by HHD ('PD + HHD' group), PD without subsequent transition to HHD ('PD only' group) and HHD without subsequent transition to PD ('HHD only' group). The composite primary outcome was death and home dialysis technique failure (defined as transfer to facility hemodialysis for at least 90 days). The secondary outcome included death on home dialysis (censored for technique failure). For all time-to-event analyses, time zero was defined as the time when HHD was initiated for patients in the 'PD+HHD' group and matching time for the other groups. Groups were compared using Cox proportional hazards models. Result(s): The 2:1 matched cohort included 84 patients in the 'PD+HHD' group, 168 patients in the 'HHD only' group and 168 patients in the 'PD only' group. Baseline characteristics were similar across the three matched groups. Compared to the 'PD +HHD' group, death and home dialysis technique failure was similar for patients treated with 'HHD only' (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.52-1.62; p=0.77) and higher for those treated with 'PD only' (HR 3.22, 95% CI 1.97-5.25; p<0.001). Similar results were observed for mo