title: Independent community house hemodialysis as a novel dialysis setting: an observational cohort study.
abstract: BACKGROUND
  There is revived interest in home hemodialysis (HD), which is spurred by cost containment and experience indicating lower mortality risk compared with facility HD and peritoneal dialysis (PD). Social barriers to home HD include disruptions to the home environment, interference with family life, overburdening of support networks, and fear of social isolation. A submodality of home HD, in which patients from urban settings undertake independent HD in unstaffed nonmedical community-based home-like settings, is described in this study. The survival of patients treated in this manner is compared with that of those using conventional home HD.
  
  
  METHODS
  An observational cohort study using the Australia and New Zealand Dialysis and Transplant Registry.
  
  
  METHODS
  All adult patients starting renal replacement therapy in New Zealand since March 31, 2000, followed up through December 31, 2010.
  
  
  METHODS
  The main predictor was time-varying dialysis modality (home HD, facility HD, PD, and community house HD), adjusting for the confounding effects of patient demographics and time-varying comorbid conditions.
  
  
  RESULTS
  Patient mortality.
  
  
  RESULTS
  4,709 patients with 12,883 patient-years of follow-up (5,591, PD; 1,532, home HD; 5,647, facility HD; and 113, community house HD) were analyzed. Community house HD patients were younger, healthier, and more likely to be Pacific people than those using other modalities, including home HD. Relative to home HD, adjusted mortality HRs were 2.18 (95% CI, 1.78-2.67) for facility HD, 2.17 (95% CI, 1.77-2.66) for PD, and 1.48 (95% CI, 0.64-3.40) for community house HD.
  
  
  CONCLUSIONS
  Small number of patients receiving community house HD, possible residual confounding from the limited collection of comorbid conditions (eg, no collection of cognitive or motor impairment), and absence of socioeconomic, medication, and biochemical data in analyses.
  
  
  CONCLUSIONS
  Within limits, this study shows community house HD to be both safe and effective. Community house HD provides an option to improve the uptake of home HD.
authors.affiliation: Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. mrmarshall@middlemore.co.nz
authors.forename: Mark R
authors.initials: MR
authors.lastname: Marshall
authors.forename: Nora
authors.initials: N
authors.lastname: van der Schrieck
authors.forename: David
authors.initials: D
authors.lastname: Lilley
authors.forename: Sharen K
authors.initials: SK
authors.lastname: Supershad
authors.forename: Alvin
authors.initials: A
authors.lastname: Ng
authors.forename: Rachael C
authors.initials: RC
authors.lastname: Walker
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Dunlop
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D016730:Program Development; D016016:Proportional Hazards Models; D006435:Renal Dialysis