title: Comparative effectiveness of home dialysis therapies: a matched cohort study.
abstract: BACKGROUND
  Home dialysis is being increasingly promoted among patients with end-stage renal disease, but the comparative effectiveness of home hemodialysis and peritoneal dialysis is unknown.
  
  
  OBJECTIVE
  To determine whether patients receiving home daily hemodialysis have reduced mortality risk compared with matched patients receiving home peritoneal dialysis.
  
  
  METHODS
  This study is an observational, propensity-matched, new-user cohort study.
  
  
  METHODS
  Linked electronic data were from the United States Renal Data System (USRDS) and a large dialysis provider's database.
  
  
  METHODS
  The patients were adults receiving in-center hemodialysis in the USA between 2004 and 2011 and registered in the USRDS.
  
  
  METHODS
  Baseline comorbidities, demographics, and outcomes for both groups were ascertained from the United States Renal Data System.
  
  
  METHODS
  We identified 3142 consecutive adult patients initiating home daily hemodialysis (≥5 days/week for ≥1.5 h/day) and matched 2688 of them by propensity score to 2688 contemporaneous US patients initiating home peritoneal dialysis. We used Cox regression to compare all-cause mortality between groups.
  
  
  RESULTS
  After matching, the two groups were well balanced on all baseline characteristics. Mean age was 51 years, 66 % were male, 72 % were white, and 29 % had diabetes. During 10,221 patient-years of follow-up, 1493/5336 patients died. There were significantly fewer deaths among patients receiving home daily hemodialysis than those receiving peritoneal dialysis (12.7 vs 16.7 deaths per 100 patient-years, respectively; hazard ratio (HR) 0.75; 95 % CI 0.68-0.82; p < 0.001). Similar results were noted with several different analytic methods and for all pre-specified subgroups.
  
  
  CONCLUSIONS
  We cannot exclude residual confounding in this observational study.
  
  
  CONCLUSIONS
  Home daily hemodialysis was associated with lower mortality risk than home peritoneal dialysis.
authors.affiliation: The Li Ka Shing Knowledge Institute, Keenan Research Center, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada ; Nephrology Program, Humber River Regional Hospital, Toronto, Ontario Canada ; Division of Nephrology, Western University, London, Ontario Canada.
authors.forename: Gihad E
authors.initials: GE
authors.lastname: Nesrallah
authors.affiliation: Division of Nephrology, Western University, London, Ontario Canada.
authors.forename: Lihua
authors.initials: L
authors.lastname: Li
authors.affiliation: Division of Nephrology, Western University, London, Ontario Canada ; Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Québec Canada.
authors.forename: Rita S
authors.initials: RS
authors.lastname: Suri