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Kidney Week

Abstract: SA-PO641

Predictors of Long-Term Patient and Technique Survival in Home Hemodialysis Patients

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Tomori, Koji, Saitama Ika Daigaku, Iruma-gun, Saitama, Japan
  • Inoue, Tsutomu, Saitama Ika Daigaku, Iruma-gun, Saitama, Japan
  • Watanabe, Yusuke, Saitama Ika Daigaku, Iruma-gun, Saitama, Japan
  • Amano, Hiroaki, Saitama Ika Daigaku, Iruma-gun, Saitama, Japan
  • Okada, Hirokazu, Saitama Ika Daigaku, Iruma-gun, Saitama, Japan
Background

Home Hemodialysis (HHD) enhances patient quality of life and survival, yet it also increases the risk of access-related complications due to the frequency of treatments. The influence of these complications on long-term treatment survival, particularly in patients with arteriovenous fistulas (AVF), remains unclear. Therefore, our study aims to follow AVF patients over a prolonged period to evaluate long-term treatment survival and identify its predictors in HHD patients.

Methods

We conducted an observational study involving all incident HHD patients at our facility from 2001 to 2020. The cumulative incidence of all-cause mortality and procedure failure (TF) as a composite outcome was calculated at 5- and 10-year intervals. Cox proportional hazards models were used to identify patient characteristics or comorbidities that predicted TF and death.

Results

A total of 77 patients (age of 50.7 years, 15.6% female, and 23.4% with diabetes) were included. All patients self-punctured their AVF, and the median frequency of dialysis was five sessions per week. During a median follow-up of 116 months, we observed 11 deaths and 19 instances of TF. Unadjusted 5- and 10-year adverse event-free survival was 83.5 and 67.2 %, respectively. Both age (aHR 1.09) and diabetes (aHR 4.17) were significantly associated with TF. Cardiovascular disease was the most frequent cause of death, and VA trouble was the primary cause of TF. VA-related TF occurred after 100 months of HHD initiation.

Conclusion

Although the long-term prognosis of HHD patients was favorable, access-related TFs occurred more frequently in patients with long-term HHD. Thus, careful management of VA is important to improve treatment survival.