Cardiovascular Outcomes in Patients on Home Hemodialysis and Peritoneal Dialysis.
In a large US registry analysis of home dialysis patients, home hemodialysis was associated with lower risks of stroke, acute coronary syndrome, cardiovascular death, and all-cause death compared with peritoneal dialysis.
Background
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease, yet little is known about how cardiovascular outcomes differ between the two main home dialysis modalities, home hemodialysis and peritoneal dialysis.
Study design
Investigators evaluated 68,645 patients who initiated home dialysis between January 2005 and December 2018 using the United States Renal Data System linked with Medicare claims. Adjusted time-to-event models examined the association of home dialysis modality with incident cardiovascular events, cardiovascular death, and all-cause death over a mean follow-up of about 1.8 years.
Key findings
Compared with peritoneal dialysis, home hemodialysis was associated with a 42 percent lower adjusted risk of stroke (hazard ratio 0.58), a 17 percent lower risk of acute coronary syndrome (hazard ratio 0.83), and no difference in heart failure risk. Home hemodialysis was also associated with a 22 percent lower adjusted risk of cardiovascular death (hazard ratio 0.78) and an 8 percent lower risk of all-cause death (hazard ratio 0.92).
Clinical implications
Relative to peritoneal dialysis, home hemodialysis was associated with decreased risk of stroke, acute coronary syndrome, cardiovascular death, and all-cause death in this observational cohort. The authors note that further studies are needed to understand the factors driving these differences between home dialysis modalities, given the limitations inherent to registry-based analyses.
Category
Research
Source
Kidney360
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