title: The risk of hospitalization and modality failure with home dialysis.
abstract: While home dialysis is being promoted, there are few comparative effectiveness studies of home-based modalities to guide patient decisions. To address this, we matched 1116 daily home hemodialysis (DHD) patients by propensity scores to 2784 contemporaneous USRDS patients receiving home peritoneal dialysis (PD), and compared hospitalization rates from cardiovascular, infectious, access-related or bleeding causes (prespecified composite), and modality failure risk. We performed similar analyses for 1187 DHD patients matched to 3173 USRDS patients receiving in-center conventional hemodialysis (CHD). The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67-0.79)). DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD). In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs. CHD: 0.93 vs. 1.10/patient-year, hazard ratio 0.92 (0.85-1.00)). Cardiovascular hospitalizations were lower with DHD than with CHD (0.68 (0.61-0.77)), while infectious and access hospitalizations were higher (1.15 (1.04-1.29) and 1.25 (1.08-1.43), respectively). Significantly more PD than DHD patients switched back to in-center HD (44% vs. 15%; 3.4 (2.9-4.0)). In this prevalent cohort, home DHD was associated with fewer admissions and hospital days than PD, and a substantially lower risk of modality failure.
authors.affiliation: 1] Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada [2] Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: Rita S
authors.initials: RS
authors.lastname: Suri
authors.affiliation: Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: Lihua
authors.initials: L
authors.lastname: Li
authors.affiliation: 1] Department of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada [2] The Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Gihad E
authors.initials: GE
authors.lastname: Nesrallah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000009:adverse effects / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D062666:Vascular Access Devices / Q000009:adverse effects / Q000706:statistics & numerical data; D055815:Young Adult