Home & satellite haemodialysis patients: A comparison of outcomes in a matched cohort

Dr Emily K Yeung1, Dr  Kevan R Polkinghorne1,2,3, Dr Peter G Kerr1,2

1Monash Health, Clayton, Australia, 2Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia, 3Department of Epidemiology & Preventative Medicine, Monash University, Clayton, Australia

Introduction

Home haemodialysis (HD) has been associated with improvements in clinical and non-clinical outcomes, including in blood pressure control, recovery time after HD, hospital days, and quality of life and survival. We compared outcomes of home HD and satellite HD patients treated at a tertiary health service.

Methods

Adult prevalent home HD patients from Monash Health were included as of January 2008, and incident patients were added to the end of June 2017. Three satellite HD controls were matched to each home HD patient on age, gender and cause of end stage kidney disease (ESRD). Survival analysis was performed by dialysis modality, and patients were followed until death, transplantation or June 30, 2017.

Results

555 patients were included with 2192 person-years of data. Mean follow-up was 4.0 years. Incidence rate of death was 7.2 per 100 person-years in satellite dialysis and 2.5 per 100 person-years in home dialysis patients. After adjusting for age, BMI, gender, racial group, cause of ESRD and comorbidities, home dialysis patients experienced a significantly reduced risk of death (HR=0.31, 95% CI 0.18-0.55).

Transplant rates were comparable between home and satellite dialysis patients – 49.7% and 45.7% (p=0.374) with graft survival at 6-months of 100% and 99.5% respectively. The proportion of patients with haemoglobin < 100g/L and with phosphate > 1.80mmol/L was not significantly different between groups.

Conclusion

This study has demonstrated a significant survival benefit for patients on home compared to matched satellite dialysis patients, with comparable rates of transplantation, transplant survival and biochemical marker control.


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