title: Patient and technique survival among a Canadian multicenter nocturnal home hemodialysis cohort.
abstract: OBJECTIVE
  As a result of improved clinical and quality-of-life outcomes compared with conventional hemodialysis, interest in nocturnal home hemodialysis (NHD) has steadily increased in the past decade; however, little is known about the flow of patients through NHD programs or about patient-specific predictors of mortality or technique failure associated with this modality. This study addressed this gap in knowledge.
  
  
  METHODS
  This study included 247 NHD patients of the Canadian Slow Long nightly ExtEnded dialysis Programs (CAN-SLEEP) cohort from 1994 through 2006 inclusive. The association between program- and patient-specific variables and risk for adverse outcomes was determined using uni- and multivariable Cox regression.
  
  
  RESULTS
  A total of 14.6% of the cohort experienced death or technique failure. Unadjusted 1- and 5-year adverse event-free survival was 95.2 and 80.1%, respectively. Significant predictors of a composite of mortality and technique failure included advanced age (P < 0.001), diabetes (P < 0.001), central venous catheter use (P = 0.01), and inability to perform NHD independently (P = 0.009) and were adjusted for center effect. Weekly frequency of NHD was not predictive. Age and diabetes remained significant with multivariable analysis (hazard ratio 1.07 and 2.64, respectively). Unadjusted 1- and 5-year technique survival was 97.9 and 95.2%, respectively. Only age was a significant predictor of technique failure.
  
  
  CONCLUSIONS
  NHD is associated with excellent adverse event-free survival. This study underscores the importance of modality-specific predictors in the success of home hemodialysis, as well as favorable baseline characteristics such as younger age and the absence of diabetes.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. robert.pauly@ualberta.ca
authors.forename: Robert P
authors.initials: RP
authors.lastname: Pauly
authors.forename: Katerina
authors.initials: K
authors.lastname: Maximova
authors.forename: Jennifer
authors.initials: J
authors.lastname: Coppens
authors.forename: Reem A
authors.initials: RA
authors.lastname: Asad
authors.forename: Andreas
authors.initials: A
authors.lastname: Pierratos
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Michael
authors.initials: M
authors.lastname: Copland
authors.forename: Gihad E
authors.initials: GE
authors.lastname: Nesrallah
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Anne
authors.initials: A
authors.lastname: Chery
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
mesh_terms: D000328:Adult; D000367:Age Factors; D002170:Canada; D002405:Catheterization, Central Venous / Q000009:adverse effects; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure