Extended Home Hemodialysis Improves Survival Outcomes Than In-Center Hemodialysis

A recent study published in the Kidney International Reports found that extended home hemodialysis (HHD) significantly improves the survival rates and overall outcomes of patients compared to in-center hemodialysis (ICHD). This discovery is set to revolutionize the way we approach treatment for patients with kidney disease.

More frequent and longer hemodialysis sessions have long been associated with better clinical outcomes for patients on dialysis. However, the adoption of home-based treatments like HHD has been limited on a global scale. This study aimed to address the gap by comparing thrice-weekly extended HHD with ICHD in a large patient population with a long-term follow-up.

The study, which included 349 patients starting HHD between 2010 and 2014, matched with 1047 concurrent patients on ICHD using propensity scores. Patients were followed up from their respective baselines until September 30, 2018.

The primary outcome was overall survival. Secondary outcomes included technique survival, hospitalization rates, and changes in clinical, laboratory, and medication parameters.

Key findings from the study revealed that HHD had a remarkable 40% lower risk for all-cause mortality compared to ICHD. The all-cause mortality rate was 3.76 per 100 patient-years in the HHD group, in stark contrast to 6.27 per 100 patient-years in the ICHD group.

Moreover, the technical survival rate for HHD was an impressive 86.5% over five years, affirming its effectiveness and long-term viability as a treatment option. Patients on HHD also benefited from better control of phosphate and blood pressure, improved nutrition, reduced inflammation, fewer days of hospitalization, and decreased medication requirements.

These results have substantial implications for the field of kidney disease treatment. Extended HHD not only offers better survival prospects but also significantly enhances the overall quality of life for patients. Furthermore, the cost-effectiveness and flexibility of home-based treatments like HHD make it a compelling option for healthcare providers and patients alike.

Reference:

Ok, E., Demirci, C., Asci, G., Yuksel, K., Kircelli, F., Koc, S. K., Mahsereci, E., Odabas, A. R., Stuard, S., Maddux, F. W., Raimann, J. G., Kotanko, P., Sezis, M., … Keleş, M. (2023). Patient Survival With Extended Home Hemodialysis Compared to In-center Conventional Hemodialysis. In Kidney International Reports. Elsevier BV. https://doi.org/10.1016/j.ekir.2023.09.007