Outcome of home haemodialysis patients: a case-cohort study.
BACKGROUND
Randomized, controlled comparisons between home haemodialysis (HHD) and centre haemodialysis (CHD) have not been performed to date. Reported survival benefits of HHD as compared with CHD from uncontrolled studies have been attributed largely to patient selection.


METHODS
In order to minimize a selection bias, we have compared the outcome of our HHD and CHD patients with a nested case-cohort study. For each patient trained for HHD at our dialysis centre between 1970 and 1995 (n=103), a corresponding match was searched from the CHD patients by retrospective chart analysis. The pairs were matched for sex, age (+/-5 years), time of dialysis therapy onset (+/-2 years) and renal disease category. For 58 of the 103 HHD patients, a corresponding matched CHD patient was identified. Both treatment groups had the same mean age (50+/-13 years) at dialysis onset and were comparable with respect to the Khan comorbidity index, prevalence and duration of hypertension, smoking habits, history of myocardial infarction, stroke and peripheral vascular disease. In both groups, approximately 50% of the patients were transplanted during the observation period.


RESULTS
HHD patients were hospitalized less often and tended to have fewer operations as compared with CHD patients. Survival was significantly longer in HHD as compared with CHD. Five, 10 and 20 year survival rates were 93 (n=55 patients at risk), 72 (41) and 34% (11) with HHD and 64 (38), 48 (26) and 23% (4) with CHD, respectively. This survival difference persisted after adjusting for predictors of mortality, i.e. age at onset of dialysis, year of start of dialysis therapy and Khan comorbidity index.


CONCLUSIONS
HHD offers a cheap and valuable alternative to CHD, with no apparent disadvantages.
Saner
Esther
E
Division of Nephrology/Hypertension, University of Bern, Freiburgstrasse, 3010 Bern - Inselspital, Switzerland. E-mail: uehlinger@mph.unibe.ch.
Nitsch
Dorothea
D
Descoeudres
Claude
C
Frey
Felix J
FJ
Uehlinger
Dominik E
DE
D000328:Adult; D000553:Ambulatory Care; D016022:Case-Control Studies; D015331:Cohort Studies; D004522:Educational Status; D004651:Employment; D005260:Female; D006304:Health Status; D006437:Hemodialysis, Home; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome