Longer Survival for Kidney Transplants Compared with Home Hemodialysis

Patients who received kidney transplants survived longer than age-matched patients who underwent home hemodialysis in two studies presented at Kidney Week.

Previous studies found that kidney failure patients on long-term dialysis tend to die earlier than patients who receive kidney transplants, but none of the studies considered death rates in US patients using alternative forms of dialysis such as home hemodialysis.

To help shed light on that question, Miklos Zsolt Molnar, MD, PhD, FASN, of the University of Tennessee Health Science Center and his colleagues compared information on 2000 patients who started home hemodialysis with 2000 patients who received kidney transplants in the US between 2007 and 2011. Over 5 years of follow-up, home hemodialysis patients were 4 times more likely to die than kidney transplant recipients.

Also, there was an interaction with race in the association of treatment modality with mortality,” said Dr. Molnar. “In African Americans, mortality risk increased after the first year as the survival lines were separated only after this time-point, while in whites the survival lines were separated from the beginning of the follow-up.” More research is needed to elucidate the reasons underlying racial differences in the risk of premature death in home hemodialysis vs. kidney transplant patients, Dr. Molnar said.

In a second study, Dr. Molnar and his team compared mortality rates in 480 elderly (>65 years old) patients using home hemodialysis with 480 matched kidney transplant recipients. The home hemodialysis patients had nearly a 5-times higher risk of dying during follow-up than did kidney transplant patients. Results were consistent across different types of kidney donors and subgroups divided by various recipient characteristics.

Still to be determined is whether kidney transplantation provides better quality of life or lower hospitalization rates compared with home hemodialysis in elderly individuals with end stage renal disease, Dr. Molnar said.

“Racial Differences in Survival of Incident Home Hemodialysis and Kidney Transplant Patients” (Abstract FR-PO1007).

“Survival of Elderly Incident Home Hemodialysis and Kidney Transplant Patients” (Abstract FR-PO1008).