Clinical Outcome of Home Hemodialysis in Patients with Previous Peritoneal Dialysis Exposure: Evaluation of the Integrated Home Dialysis Model

Overview

Journal Perit Dial Int

Publisher Sage Publications

Date 2014 Mar 4

PMID 24584602

Citations 10

Authors

Annie-Claire Nadeau-Fredette

Joanne M Bargman

Christopher T Chan

Affiliations

Soon will be listed here.

Abstract

Background: Home dialysis is a cost-effective modality of renal replacement therapy associated with excellent outcomes. Peritoneal dialysis (PD) is the most common home-based modality, but technique failure remains a problem. Transfer from PD to home hemodialysis (HHD) allows the patient to continue with a home-based modality, but the outcomes of patients transitioning to HHD after PD are largely unknown.

Methods: In a retrospective cohort study, including all consecutive HHD patients between January 1996 and December 2011, we evaluated the outcomes of patients with previous PD exposure compared to those without. The primary outcome was the cumulative patient and technique survival. Secondary outcomes included time to first hospitalization and hospitalization rate. Data were compared using the log-rank test and a multivariable Cox proportional hazards model.

Results: Among our cohort of 207 consecutive HHD patients, 35 (17%) had previous exposure to PD. Median renal replacement therapy (RRT) vintage (12.3 years, interquartile range (IQR) 8.5 - 18.9 vs 0.9 years, IQR 0.2 - 7.5, p < 0.001) and Charlson comorbidity index (CCI) (4, IQR 2 - 6 vs 3, IQR 2 - 4, p = 0.044) were higher among patients with PD exposure than those without. Despite the difference in vintage, cumulative patient and technique survival was similar in the two groups, in both unadjusted (log-rank p = 0.893) and Cox adjusted models (hazard ratio (HR) 1.15, 95% confidence interval (CI) 0.51 - 2.59) for patients with PD exposure compared to those without. The time to first hospitalization was shorter in patients with previous PD exposure compared to PD-naïve patients (log-rank p = 0.021). This association was preserved in the Cox proportional model (HR 1.65, 95% CI 1.08 - 2.54).

Conclusion: Despite a higher burden of comorbidity, patients with previous PD exposure had similar cumulative patient and technique survival on HHD compared to those without PD exposure. Whenever possible, HHD should be considered in PD patients in need of a new dialysis modality.

Citing Articles

Personalized peritoneal dialysis prescription-beyond clinical or analytical values.

Slon-Roblero M, Sanchez-Alvarez J, Bajo-Rubio M Clin Kidney J. 2024; 17(Suppl 1):i44-i52.

PMID: 38846417 PMC: 11151113. DOI: 10.1093/ckj/sfae080.

Integrated home dialysis model: facilitating home-to-home transition.

Desbiens L, Bargman J, Chan C, Nadeau-Fredette A Clin Kidney J. 2024; 17(Suppl 1):i21-i33.

PMID: 38846416 PMC: 11151120. DOI: 10.1093/ckj/sfae079.

Peritoneal dialysis discontinuation: to the root of the problem.

Piarulli P, Vizzardi V, Alberici F, Riva H, Aramini M, Regusci L J Nephrol. 2023; 36(7):1763-1776.

PMID: 37747660 PMC: 10543152. DOI: 10.1007/s40620-023-01759-w.

Mortality Trends After Transfer From Peritoneal Dialysis to Hemodialysis.

Nadeau-Fredette A, Sukul N, Lambie M, Perl J, Davies S, Johnson D Kidney Int Rep. 2022; 7(5):1062-1073.

PMID: 35570995 PMC: 9091783. DOI: 10.1016/j.ekir.2022.02.016.

Integrated care: enhancing transition from renal replacement therapy options to home haemodialysis.

Roblero M, Borman N, Bajo Rubio M Clin Kidney J. 2020; 13(1):105-110.

PMID: 32082558 PMC: 7025339. DOI: 10.1093/ckj/sfz140.

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