Abstract: FR-OR053
A Comparison of Patient and Technique Survival on Peritoneal Dialysis and Home Hemodialysis in Canada
Session Information
- Home Hemodialysis
November 03, 2017 | Location: Room 295, Morial Convention Center
Abstract Time: 05:30 PM - 05:42 PM
Category: Dialysis
- 604 Home and Frequent Dialysis
Authors
- Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
- Tennankore, Karthik K., Dalhousie/Nova Scotia Health, Halifax, Nova Scotia, Canada
- Bargman, Joanne M., Toronto General Hospital, Toronto, Ontario, Canada
- Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
Background
Improved outcomes and superior cost effectiveness among home dialysis patients compared to conventional hemodialysis has led to greater utilization of home dialysis in Canada. Little is known about survival comparisons among home dialysis modalities. This study aimed to compare the survival and technique failure of patients treated with either peritoneal dialysis (PD) or home hemodialysis (HHD).
Methods
All incident dialysis patient treated with PD or HHD within 180 days of renal replacement therapy start in Canada between January 2000 and December 2013 were analyzed. The primary outcome of death was assessed in a Cox proportional hazards model adjusting for baseline demographics, comorbidities, dialysis vintage, era and geographic region, and censored at time of transplantation or loss to follow-up. A sensitivity analysis was performed using a 2:1 propensity score matched (PSM) model. Secondary outcomes included the composite of home dialysis technique failure and death.
Results
The study included 14 589 PD patients and 721 HHD patients. Unadjusted 5-year survival was 77% for HHD patients and 52% for PD patients. In the adjusted analysis, patient mortality was lower with HHD compared to PD (adjusted hazard ratio [AHR] 0.62, 95% confidence interval [CI] 0.50-0.78, p<0.001) and the association was consistent in the PSM model (HR 0.73, 95% CI 0.56-0.95, p=0.02). The composite of on-treatment mortality and technique failure was also lower with HHD compared to PD (AHR 0.48, 95% CI 0.42-0.72, p<0.001).
Conclusion
In Canada, incident HHD was associated with a lower mortality compared to PD. Whether or not this association is related to the impact of dialysis modality or due to differences in patient selection remains uncertain and should be evaluated in further prospective studies.
Adjusted survival