According to recently published results, home hemodialysis treatment centers may impact technique failure and patient mortality independent of case-mix.
“When it comes to home hemodialysis, it turns out that what we do and how we do it likely impact patients’ outcomes,” study co-author Robert P. Pauly, MD, MSc, told Healio.com/Nephrology. “This may be because programs have variable experience in care delivery or different philosophies of care. Either way, there was considerable opportunity to move toward best practices.”
Researchers performed a retrospective cohort study of 579 patients from seven home hemodialysis centers in Canada. Patients were followed for a mean of 2.6 years. Outcomes assessed included technique failure and mortality. Technique failure included the discontinuation of home hemodialysis therapy for any reason apart from training failure, death or transplantation. Investigators used Cox proportional hazard models and adjusted for treatment center and modiﬁable and nonmodiﬁable patient-level variables.
Results showed the mean duration of dialysis was 31.2 hours per week. Investigators noted a strong predictor of technique failure was the treatment center, with hazard ratios between 0.37 to 5.11. For mortality, the hazard ratios were between 0.17 to 8.73. Older age and more than three treatments per week remained significant predictors for technique failure after baseline adjustment for center. The unadjusted 1-year technique survival was 90% and the 2-year technique survival was 83%. The overall technique survival at 1 year and 2 years was 94% and 87%, respectively.
According to researchers, 11 patients experienced training failure and never went on to perform independent home hemodialysis and 179 patients remained on home hemodialysis therapy. There were 112 patients who received a kidney transplant, 115 patients experienced treatment failure and underwent modality conversion to conventional in-center hemodialysis. Investigators noted 102 patients died. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.