Short daily-, nocturnal- and conventional-home hemodialysis have similar patient and treatment survival

Kidney Int. 2018 Jan;93(1):188-194. doi: 10.1016/j.kint.2017.06.014. Epub 2017 Aug 23.


Home hemodialysis (HHD) has many benefits, but less is known about relative outcomes when comparing different home-based hemodialysis modalities. Here, we compare patient and treatment survival for patients receiving short daily HHD (2-3 hours/5 plus sessions per week), nocturnal HHD (6-8 hours/5 plus sessions per week) and conventional HHD (3-6 hours/2-4 sessions per week). A nationally representative cohort of Canadian HHD patients from 1996-2012 was studied. The primary outcome was death or treatment failure (defined as a permanent return to in-center hemodialysis or peritoneal dialysis) using an intention to treat analysis and death-censored treatment failure as a secondary outcome. The cohort consisted of 600, 508 and 202 patients receiving conventional, nocturnal, and short daily HHD, respectively. Conventional-HHD patients were more likely to use dialysis catheter access (43%) versus nocturnal or short daily HHD (32% and 31%, respectively). Although point estimates were in favor of both therapies, after multivariable adjustment for patient and center factors, there was no statistically significant reduction in the relative hazard for the death/treatment failure composite comparing nocturnal to conventional HHD (hazard ratio 0.83 [95% confidence interval 0.66-1.03]) or short daily to conventional HHD (0.84, 0.63-1.12). Among those with information on vascular access, patients receiving nocturnal HHD had a relative improvement in death-censored treatment survival (0.75, 0.57-0.98). Thus, in this national cohort of HHD patients, those receiving short daily and nocturnal HHD had similar patient/treatment survival compared with patients receiving conventional HHD.

Keywords: conventional hemodialysis; daily hemodialysis; home hemodialysis; short nocturnal hemodialysis; survival; treatment survival.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Canada
  • Female
  • Hemodialysis, Home / adverse effects
  • Hemodialysis, Home / methods*
  • Hemodialysis, Home / mortality
  • Humans
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / mortality
  • Renal Insufficiency, Chronic / therapy*
  • Risk Factors
  • Time Factors
  • Treatment Outcome