Home dialysis: Daily, nightly, conventionally all have the same patient/treatment survival
Home hemodialysis (HHD) has many benefits for the patients, but to date there are not enough studies comparing the outcomes of different home-based hemodialysis modalities, say scientists at the University of Toronto in Canada (Tennankore KK et al, Short daily-, nocturnal- and conventional-home hemodialysis have similar patient and treatment survival.
Kidney Int. 2018;93:188-194). To fill this data gap, the authors compared patient and treatment survival under three different regimes (short daily, nocturnal and conventional), and found that daily and nocturnal HHD led to similar patient/treatment survival as conventional HHD.
Short daily HHD consisted of 2-3 hours / 5 plus sessions per week (n=202), nocturnal HHD was administered 5-8 hours / 5 plus sessions per week (n=508), and the schedule of conventional HHD was 3-6 hours / 2-4 sessions per week (n=600). The primary outcome was death or treatment failure (defined as a permanent return to in-center hemodialysis or peritoneal dialysis), the secondary outcome was death-censored treatment failure.
After multivariable adjustment for patient and center factors, the authors found no statistically significant reduction in the relative hazard for the death/treatment failure composite comparing nocturnal to conventional HHD (hazard ratio 0.83) or short daily to conventional HHD (0.84). Patients receiving nocturnal HHD had a relative improvement in death-censored treatment survival (0.75).
HHD patients who receive short daily and nocturnal HHD have similar patient/treatment survival compared with patients receiving conventional HHD, conclude the authors.