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Kidney Week

Abstract: FR-OR055

Therapy Attrition on Nocturnal versus Diurnal Home Hemodialysis

Session Information

  • Home Hemodialysis
    November 03, 2017 | Location: Room 295, Morial Convention Center
    Abstract Time: 05:54 PM - 06:06 PM

Category: Dialysis

  • 604 Home and Frequent Dialysis


  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States

Nocturnal hemodialysis offers several clinical advantages over diurnal hemodialysis, including slower ultrafiltration rate and increased cumulative phosphorus clearance. In addition, because nocturnal hemodialysis transfers treatment time to overnights, patients may gain daytime hours for activity unrelated to health care. Recently, the NxStage System One (NSO) was cleared by the US Food and Drug Administration for nocturnal home hemodialysis (NHHD). We aimed to identify the relative risk of all-cause and cause-specific therapy attrition in NHHD patients and diurnal HHD patients using the NSO.


We analyzed data in prescription records maintained by NxStage Medical (Lawrence, MA). We identified all US patients who initiated NHHD between April 1, 2015, and December 31, 2016. We also identified all US patients who initiated HHD between April 1, 2006, and December 31, 2016. For all patients, we collected age, race, sex, and year of HHD initiation with the NSO. We followed NHHD patients from the date of NHHD initiation, followed diurnal HHD patients from HHD initiation with the NSO, and followed all patients until the earlier of HHD cessation or January 15, 2015. We used stratified Cox regression to estimate hazard ratios of all-cause and cause-specific (transplant, technique failure, death) attrition for nocturnal versus diurnal HHD, with adjustment for age, race, and sex, and stratification by year of HHD initiation; in models, follow-up time was enumerated in days from HHD initiation with the NSO, in order to address HHD vintage.


We identified 406 patients who initiated NHHD. Mean age was 53.3 years, 72% with known race were white, and 68% were male. During follow-up, there were 21 transplants, 43 technique failures, and 21 deaths. Cumulative incidence of HHD attrition at 12 months after NHHD initiation was 24.9% (95% confidence interval [CI], 20.0-30.0%). Compared to diurnal HHD, hazards ratios of HHD attrition for NHHD were 0.63 (95% CI, 0.52-0.78) for all causes, 0.70 (0.45-1.08) for transplant, 0.54 (0.40-0.73) for technique failure, and 0.77 (0.54-1.12) for death.


Nocturnal HHD with the NSO was associated with lower risk of HHD attrition, with significantly lower risk of technique failure, compared to diurnal HHD. Lower risks of both transplant and death on NHHD merit further analysis, including adjustment for the comorbidity profile of NHHD patients.