Better Outcomes with HHD versus Peritoneal Dialysis

In comparison with peritoneal dialysis, patients using daily home hemodialysis (HHD) have lower mortality, fewer hospitalizations, and a lower rate of technique failure, reports a study in the American Journal of Kidney Diseases.

Using the US Renal Data System database, the researchers identified matched groups of 4201 patients starting HHD and PD from 2007 through 2010. In both groups, the average mean time from the onset of ESRD to the start of home dialysis therapy was about 44 months.

Throughout follow-up, mortality was significantly lower for patients using daily HHD than for those using PD: hazard ratio (HR) 0.80. Daily HHD was also associated with lower rates of hospitalization: HR 0.92; and technique failure, HR 0.63.

On a subset analysis of 1368 patients starting home dialysis within 6 months of ESRD onset, there was no overall difference in mortality between HHD and PD. The overall hospitalization rate was similar as well: HHD patients were at lower risk of hospitalization for cardiovascular disease and dialysis access infection, whereas PD patients were less likely to be hospitalized for bloodstream infection. The HHD group remained at lower risk of technique failure: HR 0.70.

As more patients in the US begin to use daily HHD, there are few direct comparisons of important clinical outcomes compared with PD. This matched cohort study found lower overall rates of mortality, hospitalization, and technique failure with HHD versus PD. More research is needed to clarify the interaction between home dialysis modality and duration of ESRD [Weinhandl ED, et al. Mortality, hospitalization, and technique failure in daily home hemodialysis and matched peritoneal dialysis patients: a matched cohort study. Am J Kidney Dis 2015 Aug 26. DOI: http://dx.doi.org/10.1053/j.ajkd.2015.07.014].