title: Systematic differences among patients initiated on home haemodialysis and peritoneal dialysis: the fallacy of potential competition.
abstract: BACKGROUND
  The adoption of home-based dialysis therapies is growing internationally. There is a possibility that competition for patients may exist between peritoneal dialysis (PD) and home haemodialysis (HHD) for their respective growth.
  
  
  METHODS
  Clinical demographics of patients initiating PD and HHD from 2004 to 2008 in our centre were abstracted using institutional electronic records. We compared clinical demographics, laboratory data and process of care to describe potential factors leading to patients choosing home-based dialysis therapies.
  
  
  RESULTS
  Between 2004 and 2008, 236 patients initiated home dialysis therapy in our centre: 153 patients to PD and 83 patients to HHD. PD and HHD patients differed in age (PD 62 +/- 16 vs HHD 46 +/- 13 years; P < 0.001) and gender distribution (PD 57 vs HHD 70% male; P = 0.05). A higher proportion of PD patients had diabetes and hypertension as the primary cause of their end-stage renal disease (ESRD). In contrast, there were more patients with glomerulonephritis among the HHD cohort. Cardiovascular and peripheral vascular diseases were more common among patients on PD. HHD patients had longer ESRD vintage (PD 0.34 +/- 0.69 and HHD 4.8 +/- 6.8 years on therapy; P = 0.002). The proportion of patients receiving chronic kidney disease care was higher among PD starters (PD 86 vs HHD 65%; P < 0.001). Sixteen percent of PD patients and 9% of HHD patients initiated their home-based renal replacement therapy after an acute hospitalization without prior modality education.
  
  
  CONCLUSIONS
  There is a systematic difference between patients initiated on PD and HHD. Our data reaffirm that modality selection is a complex process. Patients on the two home therapies differ demographically and arrive through different routes. This finding suggests that the two home-based modalities are not in competition.
authors.affiliation: Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Rioux
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Bargman
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome