Outcomes in patients on home haemodialysis in England and Wales, 1997

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

1. Dorothea Nitsch1,
2. Retha Steenkamp2,
3. Charles R.V. Tomson2,
4. Paul Roderick3,
5. David Ansell2 and
6. Mark S. MacGregor4

+ Author Affiliations

1.
1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
2.
2UK Renal Registry, Southmead Hospital, Bristol, UK
3.
3Public Health Sciences and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
4.
4John Stevenson Lynch Renal Unit, Crosshouse Hospital, Kilmarnock, UK

1. Correspondence and offprint requests to: Dorothea Nitsch; E-mail: Dorothea.Nitsch@lshtm.ac.uk

* Received March 26, 2010.
* Accepted August 23, 2010.

Abstract

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 wait-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.
Keywords
Key words

* home haemodialysis
* kidney transplantation
* renal registry
* survival
* wait-listing

* © The Author 2010. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

http://ndt.oupjournals.org/content/early/2010/09/14/ndt.gfq561.abstract