Outcomes in patients on home haemodialysis in England and Wales, 1997-2005: a comparative cohort analysis.
BACKGROUND
The UK national policy promotes expansion of home haemodialysis, but there are no recent data on characteristics and outcomes of a national home haemodialysis population.


METHODS
We compared incident home haemodialysis patients in England and Wales (n = 225, 1997-2005) with age- and sex-matched incident peritoneal dialysis, hospital haemodialysis and satellite haemodialysis patients with follow-up until 31 December 2006. Cox regression analyses included time-dependent changes of wait-listing for transplantation (a proxy for health status), start of home haemodialysis and transplantation.


RESULTS
There was a median delay of 12 months between starting renal replacement therapy (RRT) and home haemodialysis. During that first year of RRT, > 50% of home haemodialysis patients were wait-listed for kidney transplantation; hospital haemodialysis patients had a lower rate of wait-listing over time [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.44-0.70; P < 0.001]. In crude analyses, there was a marked survival advantage of home haemodialysis patients compared with other modalities (log-rank P-value < 0.001). In adjusted analyses, being on home haemodialysis yielded a long-term survival benefit compared with peritoneal dialysis (HR 0.61, 95% CI 0.40-0.93), and a borderline advantage compared with hospital haemodialysis (HR 0.68, 95% CI 0.44-1.03). There was no evidence of an advantage compared with satellite haemodialysis (HR 0.94, 95% CI 0.65-1.37).


CONCLUSIONS
Home haemodialysis patients have better survival compared with other dialysis modalities. Some of this crude survival advantage is due to selection of a healthier patient cohort as evidenced by higher transplant wait-listing rates. The advantage over peritoneal dialysis persisted after adjustment for wait-listing and transplantation over time.
Nitsch
Dorothea
D
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. Dorothea.Nitsch@lshtm.ac.uk
Steenkamp
Retha
R
Tomson
Charles R V
CR
Roderick
Paul
P
Ansell
David
D
MacGregor
Mark S
MS
D016022:Case-Control Studies; D015331:Cohort Studies; D004739:England; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006437:Hemodialysis, Home; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014850:Waiting Lists; D014852:Wales