Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients.
BACKGROUND
Kidney transplantation is the gold standard renal replacement therapy. Nocturnal haemodialysis (NHD) is an intensive dialysis modality (6-8 h/session, 3-7 sessions/week) associated with a significant improvement of clinical and biochemical parameters compared to conventional dialysis. To date, no studies have compared survival in patients treated with NHD and kidney transplantation.


METHODS
Using data from two regional NHD programmes and the USRDS from 1994 to 2006, we performed a matched cohort study comparing survival between NHD and deceased and living donor kidney transplantation (DTX and LTX) by randomly matching NHD patients to transplant recipients in a 1:3:3 ratio. The independent association of treatment modality with survival was determined using Cox multivariate regression.


RESULTS
The total study population consisted of 177 NHD patients matched to 1062 DTX and LTX recipients (total 1239 patients) followed for a maximum of 12.4 years. During the follow-up period, the proportion of deaths among NHD, DTX and LTX patients was 14.7%, 14.3% and 8.5%, respectively (P = 0.006). We found no difference in the adjusted survival between NHD and DTX (HR 0.87, 95% CI 0.50-1.51; NHD reference group), while LTX survival was better (HR 0.51, 95% CI 0.28-0.91).


CONCLUSIONS
These results indicate that NHD and DTX survival is comparable, and suggest that this intensive dialysis modality may be a bridge to transplantation or even a suitable alternative in the absence of LTX in the current era of growing transplant waiting lists and organ shortage.
Pauly
Robert P
RP
Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada. robert.pauly@ualberta.ca
Gill
John S
JS
Rose
Caren L
CL
Asad
Reem A
RA
Chery
Anne
A
Pierratos
Andreas
A
Chan
Christopher T
CT
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006437:Hemodialysis, Home / Q000401:mortality*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014019:Tissue Donors