Twenty-five years of experience with out-center hemodialysis.
Twenty-five years of experience with out-center hemodialysis.


BACKGROUND
Out-center hemodialysis (HD) offers patients a better quality of life, a greater independence, and a better rehabilitation opportunity. A lower mortality than with other modalities of dialysis has been reported. In addition, in France the charges paid depend on the modality of dialysis, out-center HD being the less expensive, and savings are also accomplished through fewer patient transports, which are additionally reimbursed. We present a 25-year experience of out-center HD.


METHODS
We retrospectively studied the clinical records of 471 patients treated between 1974 and 1997 in a single nonprofit organization operating regional home HD (H-HD) and facilities for self-care HD (SC-HD). Survival results were analyzed according to: (a) causes of end-stage renal disease, (b) age at the start of HD, (c) period of start of HD, (d) modality of HD (H-HD, SC-HD), and (e) a subgroup of 174 patients defined at risk because they were contraindicated for transplantation.


RESULTS
The mean age at the start of HD increased from 31.2 +/- 9.7 (mean +/- SD) years in 1974 to 52.6 +/- 13.5 years in 1997. Causes of the end of treatment were: (a) transplantation (63%), (b) transfer (20%), and (c) death (17%). The overall survival was 90% at 5 years, 77% at 10 years, 62% at 15 years, and 45% at 20 years, and, for the group at risk, 78%, 62%, 46%, and 31%, respectively. Cox proportional hazard analyses showed that risk factors were older age, diabetes, and renal vascular diseases.


CONCLUSIONS
If adequate choice is given, out-center HD offers a reliable and safe modality of dialysis with better survival results than survival in full-care in-center HD. In addition, out-center HD ensures a striking financial benefit as compared with the higher costs if the same patients were treated with full-care in-center HD. These modalities should be encouraged for all HD patients who are able to be treated by out-center modalities.
Arkouche
W
W
Association pour l'Utilisation du Rein Artificiel and Département de Néphrologie, Hôpital Edouard Herriot, Lyon, France.
Traeger
J
J
Delawari
E
E
Sibaï-Galland
R
R
Abdullah
E
E
Galland
R
R
Leitienne
P
P
Fouque
D
D
Laville
M
M
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006436:Hemodialysis Units, Hospital / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis