Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada.
A Canadian registry study found home haemodialysis was associated with better survival and fewer treatment failures than peritoneal dialysis, but the advantage narrowed in the most recent era, by which point outcomes were no longer significantly different.
Background
As interest in home dialysis grows, comparative outcomes between peritoneal dialysis (PD) and home haemodialysis (HHD) are needed to inform shared decision-making, yet head-to-head data have been very limited.
Study design
All adults initiating PD or HHD in Canada (excluding Quebec) within 365 days of kidney-replacement-therapy initiation between 2000 and 2013 were studied (959 HHD and 15,469 PD patients). Mortality and treatment failure were assessed with multivariable Cox models prespecified to stratify by era of initiation.
Key findings
Compared with PD, HHD was associated with lower mortality (adjusted HR 0.64, 95% CI 0.53-0.78) and treatment failure (aHR 0.52, 0.45-0.60). The mortality advantage was larger in earlier eras (2000-2005 aHR 0.47; 2006-2010 aHR 0.70) and not significant in the most recent era (2011-2013 aHR 0.86, 95% CI 0.51-1.47).
Clinical implications
HHD was associated with appreciably better outcomes than PD overall, but the attenuation in the contemporary era suggests improving PD outcomes; modality counselling should weigh current-era evidence rather than historical differences alone.
Category
Research
Source
Kidney International Reports
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