Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis
Introduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwid...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
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| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024923014845 |
| _version_ | 1797404587410325504 |
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| author | Ercan Ok Cenk Demirci Gulay Asci Kivanc Yuksel Fatih Kircelli Serkan Kubilay Koc Sinan Erten Erkan Mahsereci Ali Rıza Odabas Stefano Stuard Franklin W. Maddux Jochen G. Raimann Peter Kotanko Peter G. Kerr Christopher T. Chan Fatma Toz Huseyin Toz Mehmet Ozkahya Meltem Sezis Mumtaz Yilmaz Mehmet Sukru Sever Alaattin Yıldız Sıddig Momin Adam Mine Besler Handan Ogunc Mujdat Batur Canoz Mustafa Eren Melih Anil Kezban Pinar Yeniay Ismail Ozer Pınar Ergin Elif Arı Bakır Habib Emre Hüseyin Atalay Cemal Kurt Fatma Adam Pinar Seymen Numan Görgülü Bahtisen Guven Mustafa Keleş |
| author_facet | Ercan Ok Cenk Demirci Gulay Asci Kivanc Yuksel Fatih Kircelli Serkan Kubilay Koc Sinan Erten Erkan Mahsereci Ali Rıza Odabas Stefano Stuard Franklin W. Maddux Jochen G. Raimann Peter Kotanko Peter G. Kerr Christopher T. Chan Fatma Toz Huseyin Toz Mehmet Ozkahya Meltem Sezis Mumtaz Yilmaz Mehmet Sukru Sever Alaattin Yıldız Sıddig Momin Adam Mine Besler Handan Ogunc Mujdat Batur Canoz Mustafa Eren Melih Anil Kezban Pinar Yeniay Ismail Ozer Pınar Ergin Elif Arı Bakır Habib Emre Hüseyin Atalay Cemal Kurt Fatma Adam Pinar Seymen Numan Görgülü Bahtisen Guven Mustafa Keleş |
| author_sort | Ercan Ok |
| collection | DOAJ |
| description | Introduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods: We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results: The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion: These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD. |
| first_indexed | 2024-03-09T02:57:10Z |
| format | Article |
| id | doaj.art-9159ad6e44f941918f2c4520c1c3918b |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-03-09T02:57:10Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-9159ad6e44f941918f2c4520c1c3918b2023-12-05T04:15:28ZengElsevierKidney International Reports2468-02492023-12-0181226032615Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional HemodialysisErcan Ok0Cenk Demirci1Gulay Asci2Kivanc Yuksel3Fatih Kircelli4Serkan Kubilay Koc5Sinan Erten6Erkan Mahsereci7Ali Rıza Odabas8Stefano Stuard9Franklin W. Maddux10Jochen G. Raimann11Peter Kotanko12Peter G. Kerr13Christopher T. Chan14Fatma TozHuseyin TozMehmet OzkahyaMeltem SezisMumtaz YilmazMehmet Sukru SeverAlaattin YıldızSıddig Momin AdamMine BeslerHandan OguncMujdat Batur CanozMustafa ErenMelih AnilKezban Pinar YeniayIsmail OzerPınar ErginElif Arı BakırHabib EmreHüseyin AtalayCemal KurtFatma AdamPinar SeymenNuman GörgülüBahtisen GuvenMustafa KeleşEge University, Izmir, Turkey; Correspondence: Ercan Ok, Division of Nephrology, Department of Internal Medicine, Ege University School of Medicine, Bornova 35100, Izmir, Turkey.Fresenius Medical Care, Izmir, TurkeyEge University, Izmir, TurkeyEge University, Izmir, TurkeyFresenius Medical Care, Bad Homburg, GermanyFresenius Medical Care, Istanbul, TurkeyFresenius Medical Care, Izmir, TurkeyFresenius Medical Care, Gaziantep, TurkeyMedeniyet University, Istanbul, TurkeyFresenius Medical Care, Bad Homburg, GermanyFresenius Medical Care, Boston, Massachusetts, USARenal Research Institute, New York, NewYork, USARenal Research Institute, New York, NewYork, USAMonash University, Melbourne, AustraliaUniversity of Toronto, Toronto, Ontario, CanadaIntroduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods: We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results: The mean duration of dialysis session was 418 ± 54 minutes in HHD and 242 ± 10 minutes in patients on ICHD. All-cause mortality rate was 3.76 and 6.27 per 100 patient-years in the HHD and the ICHD groups, respectively. In the intention-to-treat analysis, HHD was associated with a 40% lower risk for all-cause mortality than ICHD (hazard ratio [HR] = 0.60; 95% confidence interval [CI] 0.45 to 0.80; P < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion: These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD.http://www.sciencedirect.com/science/article/pii/S2468024923014845hemodialysishome hemodialysishospitalizationmatched case-control studymedication requirementsurvival |
| spellingShingle | Ercan Ok Cenk Demirci Gulay Asci Kivanc Yuksel Fatih Kircelli Serkan Kubilay Koc Sinan Erten Erkan Mahsereci Ali Rıza Odabas Stefano Stuard Franklin W. Maddux Jochen G. Raimann Peter Kotanko Peter G. Kerr Christopher T. Chan Fatma Toz Huseyin Toz Mehmet Ozkahya Meltem Sezis Mumtaz Yilmaz Mehmet Sukru Sever Alaattin Yıldız Sıddig Momin Adam Mine Besler Handan Ogunc Mujdat Batur Canoz Mustafa Eren Melih Anil Kezban Pinar Yeniay Ismail Ozer Pınar Ergin Elif Arı Bakır Habib Emre Hüseyin Atalay Cemal Kurt Fatma Adam Pinar Seymen Numan Görgülü Bahtisen Guven Mustafa Keleş Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis Kidney International Reports hemodialysis home hemodialysis hospitalization matched case-control study medication requirement survival |
| title | Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis |
| title_full | Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis |
| title_fullStr | Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis |
| title_full_unstemmed | Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis |
| title_short | Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis |
| title_sort | patient survival with extended home hemodialysis compared to in center conventional hemodialysis |
| topic | hemodialysis home hemodialysis hospitalization matched case-control study medication requirement survival |
| url | http://www.sciencedirect.com/science/article/pii/S2468024923014845 |
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