Survival Rates for Home Hemo vs. In-Center Hemo

[mallory]

Here's a link to an interesting article that finds that home hemo patients have a survival rate 61% higher than conventional hemo patients:

http://www.nephnews.com/index.phtml?src=nraa&nw=1691

Here's the article:

NephNewsWire Top Stories in Renal Care
Clinical News

Study shows lower mortality among daily HD patients vs. conventional


A study published in Hemodialysis International this week by Blagg et al. shows that patients on short daily hemodialysis had lower mortality compared to patients on conventional hemodialysis.

The researchers, using the standardized mortality ratio, looked retrospectively at 117 prevalent U.S. patients treated by short-daily hemodialysis in 2003 and 2004 and compared death rates to survival among patients reported in the 2003 data from the United States Renal Data System. Expected mortality was calculated from the USRDS and compared with observed actual mortality. Adjustments were made for differences in patient age, sex, race, and cause of renal failure. Daily hemodialysis was defined as hemodialysis 5 or more times a week, for 2 to 3.5 hours as required to ensure adequate dialysis. Patients dialyzed in the center were treated using conventional equipment and home hemodialysis patients with the PHD System manufactured by Aksys Ltd.

The SMR for the short-daily hemodialysis patients was 0.39, statistically significantly better (p<0.005) than data from the overall U.S. population of hemodialysis patients and indicating that daily hemodialysis patients had a 61% better survival.

The average age of the patients in the study was 55.5 years (19–89 years); 71 (61%) were male, 91 (78%) were Caucasian, 22 (19%) had diabetes, and 25 (21%) had hypertension as cause of their renal disease. Patients had been treated for end-stage renal disease for an average of 5 years and 4 months (2 months to 27 years) and were on daily hemodialysis for a total of 132.4 patient years and more than 34,000 dialyses “The current study shows that based on the calculated SMR, daily hemodialysis is associated with a 61% better survival than survival of U.S. hemodialysis patients in general,” the authors noted. “This improved survival is similar to that found following renal transplantation.”

The authors acknowledged that the majority of the daily hemodialysis patients studied were on home hemodialysis, and “it is known that survival is better in such patients than in patients treated by center hemodialysis. As the number of center-treated patients in the present study is small, it is not possible to assess the relative roles of home hemodialysis and more frequent hemodialysis in this group of patients….More data on patients treated by short daily hemodialysis in center will be required to sort out the roles of home hemodialysis and frequency in survival.”

[goofynina]

Eh, the way i see it is if its your time to go, its your time to go, i aint gonna trip on how long i am going to live by what i am doing,  i'd waste too much time thinking about it, i am just gonna keep on keepin' on

[mallory]

And besides, Goofynina, it doesn't compare the survival rate of hemo and PD patients, us PD patients are going to live FOREVER!

[Zach]

It does show that patients who take control of their treatments (at home) do better overall than those who sit back and let the nurses do it all.

[mallory]

It does show that patients who take control of their treatments (at home) do better overall than those who sit back and let the nurses do it all.

So true, Zach, so true.  Makes me feel like PM'ing someone with this info.

[Joe Paul]

Lost a couple nice people, I had only just met. As was said before, we all have a time to go, im just glad I said hello to those who are not with me now. Peace out

[jbeany]

How, exactly, do they "adjust for age"?  I've been talking to the patients at my center who are also interested in doing home dialysis when the program starts next month.  The ones who are going to join are all younger patients, who are capable of doing their own treatment.  They have better accesses, and better overall health in the first place.  So I have to wonder how much that skews the results of the study. 

Regardless, I want on home hemo - I'll take the better results no matter what the cause! 

[BigSky]

I would think it should be better because home patients tend to take charge of their treatment more than a majority of in center patients.

On another note has anyone used the machine or know anyone who uses the machine in the study?

I was wondering about a couple of the features.  Mainly the reuse of the tubing feature??  Things that make you go hmmm.

Requires Fewer Disposables
Because the dialyzer and blood tubing set can be used up to 30 times, there are significantly fewer supplies, meaning less storage space is required.

[Epoman]

I would think it should be better because home patients tend to take charge of their treatment more than a majority of in center patients.

On another note has anyone used the machine or know anyone who uses the machine in the study?

I was wondering about a couple of the features.  Mainly the reuse of the tubing feature??  Things that make you go hmmm.

Requires Fewer Disposables
Because the dialyzer and blood tubing set can be used up to 30 times, there are significantly fewer supplies, meaning less storage space is required.

UPDATE: BigSky changed the image. That indeed is a image of the "Aksys PHD" NOW. Which uses the tubing set up to 30 times. Before the image was of a Fresenius.

I don't believe they are talking about that machine in the image you posted for using the tubing up to 30 times, I know that the AKSYS PHD (Aksys has recently been de-listed from Nasdaq, the company is going through a major overhaul, coming out with a new machine HOPEFULLY in 2008) uses the same tubing up to 30 times. That machine is a conventional Hemodialysis machine widely used in a in-center environment.

- Epoman

[Bill Peckham]

I don't believe they are talking about that machine in the image you posted for using the tubing up to 30 times, I know that the AKSYS PHD (Aksys has recently been de-listed from Nasdaq, the company is going through a major overhaul, coming out with a new machine HOPEFULLY in 2008) uses the same tubing up to 30 times. That machine is a conventional Hemodialysis machine widely used in a in-center environment.

- Epoman

I know this one, but dang my intro isn't done.

 I'll be dialyzing tonight on my PHD - that very machine.

Okay - I'll use the Epoman technique and post my intro in parts so I will post my intro the same day as my first post - this post.

Does that technicality keep me within the bounds?

[Epoman]

I don't believe they are talking about that machine in the image you posted for using the tubing up to 30 times, I know that the AKSYS PHD (Aksys has recently been de-listed from Nasdaq, the company is going through a major overhaul, coming out with a new machine HOPEFULLY in 2008) uses the same tubing up to 30 times. That machine is a conventional Hemodialysis machine widely used in a in-center environment.

- Epoman

I know this one, but dang my intro isn't done.

 I'll be dialyzing tonight on my PHD - that very machine.

Okay - I'll use the Epoman technique and post my intro in parts so I will post my intro the same day as my first post - this post.

Does that technicality keep me within the bounds?

DAMN IT, he changed the image. He had a image of a totally different machine. A Fresenius, I believe.

Yes of course, take your time. My intro is long and I just do it in parts as well. Also Bill, that thread over at homedialysis.org about the pandemic will get a much better reply response here on IHD instead of just Gus replying back to you. You should just copy and paste it into a new thread here. 

- Epoman

[Black]

... Also Bill, that thread over at homedialysis.org about the pandemic will get a much better reply response here on IHD...- Epoman

I was thinking the same thing as I was reading that!!!

[BigSky]

UPDATE: BigSky changed the image. That indeed is a image of the "Aksys PHD" NOW. Which uses the tubing set up to 30 times. Before the image was of a Fresenius.


- Epoman

Changed what???   

Yah I  changed it before you posted.   You must have been in the process of writing your post.

[stauffenberg]

It has been known for some time that patients on home hemodialysis have better mortality and morbidity rates than those on in-center hemodialysis or periotonial dialysis.  I was shown the data when I was in training for home hemodialysis back in 2001 and there were already a number of scientific studies proving this.  However, this has absolutely nothing to do with patients "taking charge of their own treatment," but instead everything to do with the fact that the patients 1) get many more hours of dialysis time; 2) have a much more physiologic form of dialysis, since it is slower and has shorter periods of interruption; and 3) fluids are removed in less concentrated amounts.  Far from patients taking charge of their treatments on home hemodialysis, the treatment tends to take greater charge of the patients, since it invades their homes; takes up every single day of their lives, with six dialysis sessions a week and Sunday devoted to cleaning the machine; forces them to rub their noses in the treatment which represents their greatest personal tragedy, since they are like a condemned person having to build their own scaffold and tie their own noose every day; and forces them to be their own dialysis manager, since they have to devote an extra room of their house to storing bulky supplies and they have to keep track of what needs to be ordered and when, and to be at home to receive deliveries.  In my own experience it was a greater burden than being on in-center hemodialysis, where someone else was in charge of all these problems, and I just had to deal with being sick, rather than with slaving in service of the machine which symbolized the destruction of everything I had intended to accomplish with my life. I felt much more in charge of my own life when all I had to do was to go to the dialysis center three times a week, sit in an assigned chair, and read material that I had chosen for my own interests, rather than being a servant of a misfortune fate had imposed on me.

[jbeany]

forces them to rub their noses in the treatment which represents their greatest personal tragedy,   

Mein Gott, stauffenburg - that's a bit much.  Personally, I've had a whole lot worse happen to me than having to go on dialysis.  On a list of my greatest personal tragedies, this crap doesn't even make the top 10.  It sucks, yes, and I do hate it, but I've had a lot worse happen to me than this medical problem.

[BigSky]

I know this one, but dang my intro isn't done.

 I'll be dialyzing tonight on my PHD - that very machine.

Okay - I'll use the Epoman technique and post my intro in parts so I will post my intro the same day as my first post - this post.

Does that technicality keep me within the bounds?

Maybe you could give an overview and thoughts of the machine in the home dialysis section??

[Zach]

It has been known for some time that patients on home hemodialysis have better mortality and morbidity rates than those on in-center hemodialysis or periotonial dialysis.  I was shown the data when I was in training for home hemodialysis back in 2001 and there were already a number of scientific studies proving this.

Back in the 20th Century, most home dialysis programs (1982-2000) had patients perform the same 4 to 4.5 hours treatments, 3-time-a-week as in center hemodialysis.  Yet with that "limited" amount of treatment, those home hemo patients had far better mortality and morbidity rates than those on in-center hemo.  Yes, it does have to do with taking charge of your treatment (not just the diet).  Even in-center dialysis programs which were "self-care" had better mortality and morbidity rates than those receiving "chronic care."

[Bill Peckham]

I know this one, but dang my intro isn't done.

 I'll be dialyzing tonight on my PHD - that very machine.

Okay - I'll use the Epoman technique and post my intro in parts so I will post my intro the same day as my first post - this post.

Does that technicality keep me within the bounds?

Maybe you could give an overview and thoughts of the machine in the home dialysis section??

If you need to know now my thoughts are pretty well spelled out over at HDC but I could try to put together a snap shot of what I think as of today about my PHD experience - I was the first on and will probably be the last off. I stopped by the Aksys Headquarters when I was back in the Chicago area for Christmas - there's a thread about that over on HDC. I've also trained on the NxStage and have to date taken it on two trips. In February I'm taking it to DC. And I used the B Braun at home for a year.

Some day all this will be in the introduction, really.

[Bill Peckham]

How, exactly, do they "adjust for age"? 

It just means that when comparing an incenter dialyzor's outcome with a home dialyzor's outcome they took into consideration differences in age. Obviously the young (those bastards) tend to naturally outlive the old so to make a fair comparison you have to "adjust" the data to reflect differences between the two groups in terms of age and co-morbidities.

Adjusting does make it sound like they are massaging the data, twisting it but done correctly it makes the data from different groups more comparable.

[jedimaster]

Regardless of my common complaints, I would not trade my home hemo for a clinic hemo...it is a lot of work, but I´m in charge, and that is good enough for me. If I´m to live longer or shorter than the rest...only God knows...every day is a day I can enjoy my family and friends...

[AlasdairUK]

I would imagine that statistics for people who are eligible to do home hemo, but continue to do in-centre would be similar to those of home hemo patients. In my view this is because the majority of in-centre patients are high care and would not be suitable for home hemo. This creates a distortion between in-centre and home hemo mortality rates.

People who are able to run their machine be it in-centre or home hemo have a greater knowledge in the process of dialyzing and what causes the various side effects and how to reduce them.   

[Zach]

People who are able to run their machine be it in-centre or home hemo have a greater knowledge in the process of dialyzing and what causes the various side effects and how to reduce them.   

How right you are!
 

[stauffenberg]

Alasdair is right in his first point, though I am not sure if the second makes any difference.  The fact that only the healthier patients are selected for home hemodialysis would in itself improve the morbidity and mortality rates for those on home hemodialysis, regardless of the benefit of the change in the therapeutic modality.  But I suspect that in the studies of different outcomes for home and in-center patients, the confounding variable of only healthier patients being selected for the former modality is factored out, since otherwise the data would not be measuring what they purport to measure.