Lower Risks of Stroke and Cardiovascular Death Associated with Home Hemodialysis Over Peritoneal Dialysis: Study

Relative to peritoneal dialysis, home hemodialysis is associated with a reduced risk of stroke, cardiovascular death, acute coronary syndrome, and all-cause death, the researchers reported in Kidney360 Journal. They stress the need for further studies to understand better the factors associated with differences in CV outcomes by type of home dialysis modality in patients with kidney failure.

Home hemodialysis involves using a machine to filter blood, which is performed several times a week in the comfort of the patient’s home. It contrasts with peritoneal dialysis, where the patient’s abdominal cavity is used to filter blood, typically done daily.

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in patients with end-stage kidney disease (ESKD). Considering that there is limited knowledge on differences in CV outcomes between HHD and PD, Silvi Shah, University of Cincinnati, Cincinnati, OH, and colleagues aimed to compare the risks of CV events, CV death, and all-cause death in patients on daily HHD and PD.

For this purpose, the researchers evaluated 68,645 patients who initiated home dialysis between 2005 and 2018 using the United States Renal Data System with linked Medicare claims. They determined rates for incident cardiovascular events of acute coronary syndrome, stroke hospitalizations, and heart failure. Adjusted time-to-event models were utilized to investigate how different types of home dialysis modalities are associated with incident cardiovascular events, cardiovascular mortality, and all-cause mortality.

Based on the study, the researchers reported the following findings:

• The mean age of patients in the study cohort was 64±15 years, and 42.3% were women. The mean time of follow-up was 1.8±1.6 years.
• The unadjusted cardiovascular event rate was 95.1 per thousand person-years (PTPY), with a higher rate in patients on HHD than on PD (127.8 PTPY versus 93.3 PTPY).
• HHD was associated with a slightly lower adjusted risk of cardiovascular events than PD (hazard ratio [HR], 0.92).
• Compared with patients on PD, patients on HHD had 42% lower adjusted risk of stroke (HR, 0.58), 17% lower adjusted risk of acute coronary syndrome (HR, 0.83), and no difference in risk of heart failure (HR, 1.05).
• HHD was associated with a 22% lower adjusted risk of cardiovascular death (HR, 0.78) and an 8% lower adjusted risk of all-cause death (HR, 0.92) as compared with PD.

"Home hemodialysis is linked to reduced adjusted risks for cardiovascular events, including stroke and acute coronary syndrome, as well as lower adjusted risks for cardiovascular mortality and all-cause mortality compared to peritoneal dialysis," the researchers concluded.

Reference:

Shah, Silvi1; Weinhandl, Eric2,3; Gupta, Nupur4; Leonard, Anthony C.5; Christianson, Annette L.5; Thakar, Charuhas V.1,6,7. Cardiovascular Outcomes in Patients on Home Hemodialysis and Peritoneal Dialysis. Kidney360 5(2):p 205-215, February 2024. | DOI: 10.34067/KID.0000000000000360