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Abstract: FR-OR001

Relative Survival among Incident Patients on Home Versus In-Center Hemodialysis

Session Information

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

Relatively little research has been aimed at outcomes among incident dialysis patients who undergo home hemodialysis (HHD). Percolating interest in transitional dialysis care may result in greater utilization of HHD during the first year of dialysis. We assessed relative survival among incident patients on HHD versus in-center hemodialysis (IHD).

Methods

We analyzed merged data from the United States Renal Data System. HHD patients initiated at-home treatment with the NxStage System One between January 1, 2006, and December 31, 2012, and within 3 months after dialysis initiation. IHD patients underwent treatment in a dialysis facility at 45 days after dialysis initiation. We followed HHD patients from the day of the first at-home treatment and IHD patients from the 45th day after dialysis initiation; all patients were followed until death, but for a maximum of one year. We used Cox regression to estimate the adjusted hazard ratio (AHR) of death for HHD versus IHD, with adjustment for age, race, sex, primary cause of end-stage renal disease, Medicaid enrollment, comorbid conditions, vascular access type, body mass index, estimated glomerular filtration rate (GFR), and hematocrit; all adjustment factors were ascertained from form CMS-2728.

Results

We identified 1773 HHD patients and 555,366 IHD patients. Relative to IHD patients, HHD patients were younger (mean age, 55.3 versus 60.3 years), more likely white (81.3% versus 62.7%), more likely male (71.1% versus 57.0%), less likely enrolled in Medicaid (9.5% versus 28.3%), and less likely to have heart failure (15.8% versus 31.3%). Mean estimated GFR was 10.5 and 10.4 mL/minute/1.73 m2 in HHD and IHD patients, respectively. Survival after one year of follow-up was 91.7% and 81.4% in HHD and IHD patients, respectively. After adjustment, the AHR of death for HHD versus IHD was 0.77 (95% confidence interval, 0.66-0.91). Within age strata, corresponding AHRs of death were 0.56 (0.30-1.04) for 20-44 years, 0.74 (0.58-0.94) for 45-64 years, and 0.89 (0.70-1.13) for ≥65 years. Within estimated GFR strata, corresponding AHRs of death were 0.68 (0.51-0.90) for GFR <10 mL/minute/1.73 m2 and 0.80 (0.65-1.00) for GFR ≥10 mL/minute/1.73 m2.

Conclusion

Among incident patients, HHD is associated with better survival than IHD. Associations are attenuated with older age and higher estimated GFR at dialysis initiation.

Funding

  • Commercial Support