title: An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry).
abstract: OBJECTIVE
  Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited.
  
  
  METHODS
  This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model.
  
  
  RESULTS
  The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality.
  
  
  CONCLUSIONS
  Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Medicine, Université de Montreal, Montreal, Canada;
authors.forename: Annie-Claire
authors.initials: AC
authors.lastname: Nadeau-Fredette
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia;
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Australia;
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Pascoe
authors.affiliation: Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada;
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Sydney Medical School, University of Sydney, Sydney, Australia;
authors.forename: Philip A
authors.initials: PA
authors.lastname: Clayton
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Australia; Departments of Medicine, Epidemiology, and Preventative Medicine, Monash University, Melbourne, Australia; and.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Boudville
authors.affiliation: Department of Medicine, Université de Montreal, Montreal, Canada;
authors.forename: Martine
authors.initials: M
authors.lastname: Leblanc
authors.affiliation: Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia; david.johnson2@health.qld.gov.au.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D004868:Equipment Failure; D005260:Female; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: hemodialysis; peritoneal dialysis; survival