title: An international feasibility study of home haemodialysis in older patients.
abstract: BACKGROUND
  Home haemodialysis (HHD) is undergoing a significant revival. There is a global demographic shift with a rising mean age of dialysis patients. We postulated that intensive HHD may also benefit the older dialysis population. However, there is a lack of literature on the feasibility of HHD in older patients with end-stage renal disease (ESRD). The purpose of this study was to ascertain the feasibility of delivering HHD to older patients.
  
  
  METHODS
  We conducted a multi-centre multinational retrospective cohort study of HHD patients ≥65 years of age at the time of HHD initiation; 79 patients were included. Baseline demographic data included age at start of dialysis, race and sex. Dialysis characteristics including total weekly treatment hours, need for assistance, training time, dialysis access, modality and dialysis vintage were captured, as well as cause of ESRD and medical co-morbidities. The primary outcome was time to technique failure or death. Rates of hospitalization, cardiovascular events, non-infectious vascular access events and infections were collected.
  
  
  RESULTS
  Median age at start was 68 (interquartile range 66-71) years. An arteriovenous fistula was the predominant access, and most patients were receiving <16 h of total weekly dialysis treatment. Family or nurse assistance for dialysis was required in 54% of patients. There were 17 (22%) deaths and 20 (26%) technique failures. The cumulative time at risk was 188 years. Event-free survival at 1, 2 and 5 years was 85, 77 and 24%, respectively, and technique survival was 92, 83 and 56%, respectively. Advancing age (categorized into quartiles) was an unadjusted risk factor for death and technique failure.
  
  
  CONCLUSIONS
  This analysis confirms feasibility of HHD in patients 65 years or older at the start of this modality and should foster further research on the potential benefits of (intensive) HHD in older ESRD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Cornelis
authors.affiliation: Division of Nephrology, Department of Medicine, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Karthik K
authors.initials: KK
authors.lastname: Tennankore
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Goffin
authors.affiliation: Division of Nephrology, Department of Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Virpi
authors.initials: V
authors.lastname: Rauta
authors.affiliation: Division of Nephrology, Department of Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Honkanen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen and Dialysis Centre Groningen, Groningen, The Netherlands.
authors.forename: Akin
authors.initials: A
authors.lastname: Őzyilmaz
authors.affiliation: Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Vijay
authors.initials: V
authors.lastname: Thanaraj
authors.affiliation: Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Jayanti
authors.affiliation: Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Sandip
authors.initials: S
authors.lastname: Mitra
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.affiliation: Division of Nephrology, Department of Medicine, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006437:Hemodialysis, Home / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: elderly; feasibility; home haemodialysis; intensive haemodialysis; outcomes