title: The feasibility of caregiver-assisted home nocturnal hemodialysis.
abstract: OBJECTIVE
  Home nocturnal hemodialysis (HNHD) has several benefits. However, patients that require caregiver assistance for dialysis may be at risk for poor outcomes. In an effort to determine if HNHD can be extended to assisted patients, an analysis of their outcomes is important.
  
  
  METHODS
  We examined a single-center cohort of patients that started and completed HNHD training between 01 January 2003 and 31 December 2010 (last follow-up 01 July 2011). Patients were classified as 'dependent' if they required caregiver assistance for dialysis. The primary outcome was time to first hospitalization, technique failure, or death for dependent versus independent patients. Secondary outcomes included hospitalization rate and hospital days.
  
  
  RESULTS
  A total of 152 patients were included in this study. Dependent patients (n = 47) were older (51 vs. 42 years), more likely to have diabetic end-stage renal disease (26 vs. 8%) and had higher Charlson Comorbidity Index scores (4 vs. 3) compared to independent patients (n = 105). In an adjusted analysis there was no significant difference in the time to composite outcome for dependent versus independent patients (relative hazard 1.25; 95% confidence interval, CI, 0.76-2.04). Adjusted incidence rate ratios for hospitalizations (1.58; 95% CI 0.95-2.65) and hospital days (1.84; 95% CI 0.78-4.34) were not significantly different for dependent versus independent patients.
  
  
  CONCLUSIONS
  Our study suggests that outcomes of caregiver-assisted versus independent HNHD patients are likely driven by differences in case mix. The need for caregiver assistance alone should not be a deterrent to HNHD.
authors.affiliation: University Health Network/Toronto General Hospital, University of Toronto, Toronto, Ont, Canada. ktennankore @ gmail.com
authors.forename: Karthik K
authors.initials: KK
authors.lastname: Tennankore
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
mesh_terms: D000328:Adult; D017028:Caregivers; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006437:Hemodialysis, Home; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome