Survival and hospitalization in home versus Institutional hemodialysis-nine years of follow up.

Abstract

Increasing interest in home dialysis treatments are driven by better outcomes, less complications, patients desire and economic reasons. We compared 26 prevalent home hemodialysis (HHD) patients with 52 matched institutional hemodialysis patients (IHD) in survival and morbidity. Median age for HHD and IHD patients was 55,7 and 56 years respectively, and 77% were men. HHD patients had significantly better anemia control (Hgb level 12.2 ± 1.7 vs. 10.8 ± 1.3gr/dl; p = 0,001 respectively), and significantly higher albumin and cholesterol levels than IHD (42.5 ± 2 vs. 39 ± 3 g/l, p = 0.001; 5.1 ± 1 vs.4.7 ± 0.8 mmol/l, p = 0.05, respectively). During the nine years of follow up, there was no difference between groups in overall number of hospitalization (3.7 ± 3.3 vs. 3.9 ± 2.8; p = 0.47), nor in annual admission rate for everyone cause (0.5 ± 0.4 vs. 0.6 ± 0.4, p = 0.28), but IHD patients stayed longer in hospital (7.4 ± 9.8 days vs. 9.3 ± 8.7 days; p = 0.05). Cause-specific morbidity showed that IHD patients had more frequent annual admission rate for cardiovascular diseases (CVD) than HHD (0.4 ± 0.3 vs. 0.2 ± 0.1 respectively, p = 0.05), while there were no differences for infections (0.3 ± 0.3 vs. 0.3 ± 0.2 respectively, p = 0.9) nor vascular access (VA) dysfunction (0.4 ± 0.3 vs. 0.3 ± 0.3 respectively, p = 0.3). Also annual in-hospital stay for CVD (3.0 ± 3.1 vs. 4.0 ± 4.5 days; p = 0.5), infection (6,4 ± 7,5 vs. 5,7 ± 7,6 days; p = 0,6) and VA dysfunction (6.0 ± 7.0 vs. 7.7 ± 7.8 days; p = 0,5) did not differ between HHD and IHD group. As revealed by Kaplan Meier curve, survival in HHD and IHD patients were 92.3% vs. 90.4% at 3 years, 84.6% vs. 70.2% at 5 years, and 55.7% vs. 50% at 9 years (log-rank test p = 0,5). HHD provides better anemia and nutrition control; shorter hospitalizations and less frequent hospitalizations for CVD.