Abstract
Background and Aims
Many studies have compared survival of patients on peritoneal dialysis and hemodialysis, but knowledge on survival differences between various types of home dialysis is limited. Therefore, our study aimed to assess the associated survival in CAPD, APD and home HD.
Method
During 2004 to 2017, 1640 patients aged 18 years or older started RRT in Helsinki University Hospital. Patients who were on one of the home dialysis modalities at 90 days (n=536), have been studied. The follow up endpoint was either death or the end of 2019. A research database was established and extensive data were systematically collected from the patient files, comprising 35 different comorbidities, laboratory results, primary renal disease, and renal replacement therapy-related factors. Study design was intention-to-treat, and patients were analyzed in the home dialysis modality group they were at 90 days after onset of RRT. Patient survival was compared between patients on CAPD, APD, and home HD using Kaplan-Meier curves and Cox regression.
Results
Characteristics of home HD and APD patients at the start of dialysis and proportion of patients who received a kidney transplant during follow-up were similar (Table), whereas patients on CAPD had higher median age, more comorbidities, and received a kidney transplant less frequently. The probability of surviving 5 years was 56% for CAPD, 88% for APD, and 90% for home HD patients (Figure). Relative risk of death associated with APD was 0.96 (95% CI 0.60–1.5), and that of CAPD was 3.7 (2.4–5.7) as compared to home HD. After adjustment for age and number of comorbidities, the relative risks were 0.82 (0.39–1.7) and 2.5 (1.2–5.0), respectively. Additional adjustments for other possible confounding factors listed in the Table did not change the results. Censoring for kidney transplantation did not alter the conclusion.
Conclusion
APD and home HD patients had similar characteristics and comparable survival. CAPD patients were older, had more often comorbid conditions, and their prognosis was worse even after adjustment for confounders.
ESKD Treatment Choices Model: Responsible Home Dialysis Growth Requires Systems Changes
