Patient Survival With Extended Home Hemodialysis Compared to In-Center Conventional Hemodialysis
Ercan Ok, Cenk Demirci, Gülay Aşçı, Kıvanç Yüksel, Fatih Kırçelli, Serkan Koç, Sinan Erten, E. Mahsereci, Ali Rıza Odabaş, Stefano Stuard, Franklin W. Maddux, Jochen G. Raimann, Peter Kotanko, Peter G. Kerr, Christopher T. Chan, Fatma Toz, Hüseyin Töz, Mehmet Özkahya, Meltem Seziş, Mümtaz Yılmaz, Mehmet Şükrü Sever, Alaattin Yıldız, Siddik Momin Adam, Mine Besler, Handan Öğünç, Müjdat Batur Canöz, Mustafa Eren, Melih Anıl, Kezban Pınar Yeniay, İsmail Özer, Pınar Ergin, Elif Arı Bakır, Habib Emre, Hüseyin Atalay, Cemal Kurt, Fatma Ulku Adam, Pınar Seymen, Numan Görgülü, Bahtisen Guven, Mustafa Keleş
Abstract
Introduction: More frequent and/or longer hemodialysis (HD) has been associated with improvements in numerous clinical outcomes in patients on dialysis. Home HD (HHD), which allows more frequent and/or longer dialysis with lower cost and flexibility in treatment planning, is not widely used worldwide. Although, retrospective studies have indicated better survival with HHD, this issue remains controversial. In this multicenter study, we compared thrice-weekly extended HHD with in-center conventional HD (ICHD) in a large patient population with a long-term follow-up. Methods: We matched 349 patients starting HHD between 2010 and 2014 with 1047 concurrent patients on ICHD by using propensity scores. Patients were followed-up with from their respective baseline until September 30, 2018. The primary outcome was overall survival. Secondary outcomes were technique survival; hospitalization; and changes in clinical, laboratory, and medication parameters. Results: < 0.001). In HHD, the 5-year technical survival was 86.5%. HHD treatment provided better phosphate and blood pressure (BP) control, improvements in nutrition and inflammation, and reduction in hospitalization days and medication requirement. Conclusion: These results indicate that extended HHD is associated with higher survival and better outcomes compared to ICHD.