title: Mortality, Hospitalization, and Technique Failure in Daily Home Hemodialysis and Matched Peritoneal Dialysis Patients: A Matched Cohort Study.
abstract: BACKGROUND
  Use of home dialysis is growing in the United States, but few direct comparisons of major clinical outcomes on daily home hemodialysis (HHD) versus peritoneal dialysis (PD) exist.
  
  
  METHODS
  Matched cohort study.
  
  
  METHODS
  We matched 4,201 new HHD patients in 2007 to 2010 with 4,201 new PD patients from the US Renal Data System database.
  
  
  METHODS
  Daily HHD versus PD.
  
  
  RESULTS
  Relative mortality, hospitalization, and technique failure.
  
  
  RESULTS
  Mean time from end-stage renal disease onset to home dialysis therapy initiation was 44.6 months for HHD and 44.3 months for PD patients. In intention-to-treat analysis, HHD was associated with 20% lower risk for all-cause mortality (HR, 0.80; 95% CI, 0.73-0.87), 8% lower risk for all-cause hospitalization (HR, 0.92; 95% CI, 0.89-0.95), and 37% lower risk for technique failure (HR, 0.63; 95% CI, 0.58-0.68), all relative to PD. In the subset of 1,368 patients who initiated home dialysis therapy within 6 months of end-stage renal disease onset, HHD was associated with similar risk for all-cause mortality (HR, 0.95; 95% CI, 0.80-1.13), similar risk for all-cause hospitalization (HR, 0.96; 95% CI, 0.88-1.05), and 30% lower risk for technique failure (HR, 0.70; 95% CI, 0.60-0.82). Regarding hospitalization, risk comparisons favored HHD for cardiovascular disease and dialysis access infection and PD for bloodstream infection.
  
  
  CONCLUSIONS
  Matching unlikely to reduce confounding attributable to unmeasured factors, including residual kidney function; lack of data regarding dialysis frequency, duration, and dose in daily HHD patients and frequency and solution in PD patients; diagnosis codes used to classify admissions.
  
  
  CONCLUSIONS
  These data suggest that relative to PD, daily HHD is associated with decreased mortality, hospitalization, and technique failure. However, risks for mortality and hospitalization were similar with these modalities in new dialysis patients. The interaction between modality and end-stage renal disease duration at home dialysis therapy initiation should be investigated further.
authors: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN. Electronic address: e.weinhandl.phd@gmail.com.
authors: Eric D
authors: ED
authors: Weinhandl
authors: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors: David T
authors: DT
authors: Gilbertson
authors: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN.
authors: Allan J
authors: AJ
authors: Collins
mesh_terms: D015331:Cohort Studies; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods* / Q000401:mortality*; D017211:Treatment Failure
keywords: Daily home hemodialysis (HHD); US Renal Data System (USRDS); chronic kidney disease (CKD); dialysis modality; end-stage renal disease (ESRD); home dialysis; hospitalization; mortality; outcomes; peritoneal dialysis (PD); self-care dialysis; technique failure