Abstract: FR-OR004
A Comparison of Technique Survival in Canadian Peritoneal Dialysis and Home Hemodialysis Patients
Session Information
- Advances in Home Dialysis Modalities
October 26, 2018 | Location: 2, San Diego Convention Center
Abstract Time: 05:06 PM - 05:18 PM
Category: Dialysis
- 702 Dialysis: Home Hemodialysis
Authors
- Trinh, Emilie, McGill University Health Center, Montreal, Quebec, Canada
- Hanley, James A., McGill University, Montreal, Quebec, Canada
- Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Perl, Jeffrey, St. Michael's Hospital, Toronto, Ontario, Canada
- Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
Background
High discontinuation rates remain a challenge for both home hemodialysis (HHD) and peritoneal dialysis (PD). Our study aimed to compare the technique failure risks between HHD and PD in a Canadian cohort.
Methods
We studied adult patients who initiated either HHD or PD within 1 year of dialysis initiation between 2000-2012 in the Canadian Organ Replacement Register. Technique failure was defined as a transfer to any alternative dialysis modality for a period of ≥60 days. We compared technique survival between HHD and PD using a Fine and Gray competing risk model. Secondary outcomes assessed the trajectory of technique survival, the association of patient characteristics with technique failure, causes of technique failure and changes of technique failure rates over time
Results
15,314 patients were treated with a home dialysis modality between 2000-2012: 14,461 on PD and 853 on HHD. The adjusted risk of technique failure was overall lower with HHD compared to PD (HR 0.79; 95% CI 0.69-0.90). However, comparisons varied over time (Figure 1a). During the first year of therapy, there was no significant difference in technique survival between HHD and PD (HR 1.13; 95% CI 0.94-1.36). Thereafter, the risk of technique failure was significantly lower with HHD. In PD and HHD, crude rates of technique failure were the highest during the first year of therapy (Figure 1b). Among HHD patients, rates were significantly lower subsequent to that. In contrast, the decrease in failure rates was not as pronounced among PD patients. Furthermore, the majority of home dialysis discontinuation occurred for medical reasons in PD (38%) while the majority of HHD patients experienced technique failure due to social reasons or inadequate resources (50%).
Conclusion
In this Canadian study of home dialysis patients, HHD was associated with superior technique survival compared to PD. However, causes and patterns of technique failure differed significantly among these modalities. Strategies to improve patient retention across all home dialysis modalities are needed.