Associations with home hemodialysis modality failure and mortality.
BACKGROUND
Limited data exist on risk factors for home hemodialysis (HH) failure and mortality. We sought to determine whether age, helper status, or ethnicity was associated with home dialysis failure or mortality.


METHODS
We conducted a retrospective cohort study of all prevalent and incident patients from a regional dialysis unit who initiated HH training from December 2000 to September 2002. Baseline demographics, program entry and exit dates, and mortality were ascertained. Characteristics of those more likely to remain in the program were assessed using logistic regression; survival was determined using Cox proportional hazards models.


RESULTS
Of the 1117 patients enrolled for dialysis, 116 patients were trained in the HH program (6.8%). Of those, 45.7% remained in the program, 10.3% received a transplant, 10.3% returned to in-center dialysis, 1.7% were lost to follow-up, and 31.7% expired. Compared to patients who returned to center or received a transplant, patients who remained on HH were more likely to be older, to have been on dialysis longer, and to have diabetes as their primary renal disease. Ethnicity, sex, or type of helper did not affect home program status. Among those who remained in the HH program, those with hypertension or other renal diseases had better survival than those with diabetes, as did those who had related helpers compared to those with unrelated helpers.


CONCLUSIONS
Older and younger ages, but not ethnicity, helper status, or sex, were associated with home dialysis failure. Diabetes remained an independent risk factor for increased mortality. HH remains a viable option for many patients.
Young
Bessie A
BA
Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington; Northwest Kidney Centers, Seattle, Washington, U.S.A. youngb@u.washington.edu
Hynes
Janey
J
McComb
Timothy
T
Blagg
Christopher R
CR