Outcomes in patients on home haemodialysis in England and Wales, 1997–2005: a comparative cohort analysis
Nitsch, Dorothea, Steenkamp, Retha, Tomson, Charles R.V., Roderick, Paul, Ansell, David and Macgregor, Mark S. (2010) Outcomes in patients on home haemodialysis in England and Wales, 1997–2005: a comparative cohort analysis. Nephrology, Dialysis, Transplantation (doi:10.1093/ndt/gfq561 ).
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Description/Abstract
Background: The UK national policy promotes expansion of home haemodialysis, but there are no recent data on characteristics and outcomes of a national home haemodialysis population.
Methods: We compared incident home haemodialysis patients in England and Wales (n = 225, 1997–2005) with age- and sex-matched incident peritoneal dialysis, hospital haemodialysis and satellite haemodialysis patients with follow-up until 31 December 2006. Cox regression analyses included time-dependent changes of wait-listing for transplantation (a proxy for health status), start of home haemodialysis and transplantation.
Results: There was a median delay of 12 months between starting renal replacement therapy (RRT) and home haemodialysis. During that first year of RRT, > 50% of home haemodialysis patients were wait-listed for kidney transplantation; hospital haemodialysis patients had a lower rate of wait-listing over time [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.44–0.70; P < 0.001]. In crude analyses, there was a marked survival advantage of home haemodialysis patients compared with other modalities (log-rank P-value < 0.001). In adjusted analyses, being on home haemodialysis yielded a long-term survival benefit compared with peritoneal dialysis (HR 0.61, 95% CI 0.40–0.93), and a borderline advantage compared with hospital haemodialysis (HR 0.68, 95% CI 0.44–1.03). There was no evidence of an advantage compared with satellite haemodialysis (HR 0.94, 95% CI 0.65–1.37).
Conclusions: Home haemodialysis patients have better survival compared with other dialysis modalities. Some of this crude survival advantage is due to selection of a healthier patient cohort as evidenced by higher transplant wait-listing rates. The advantage over peritoneal dialysis persisted after adjustment for wait-listing and transplantation over time.
| Item Type: | Article |
|---|---|
| ISSNs: | 0931-0509 (print) 1460-2385 (electronic) |
| Subjects: | H Social Sciences > HA Statistics R Medicine > RC Internal medicine |
| Divisions: | University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences |
| Item ID: | 164113 |
| Date Deposited: | 21 Sep 2010 09:27 |
| Last Modified: | 07 Jun 2011 08:39 |
| Contributors: | Nitsch, Dorothea (Author) Steenkamp, Retha (Author) Tomson, Charles R.V. (Author) Roderick, Paul (Author) Ansell, David (Author) Macgregor, Mark S. (Author) |
| Date: | 14 September 2010 |
| Status: | Published |
| URI: | http://eprints.soton.ac.uk/id/eprint/164113 |
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