Mortality After Home Hemodialysis Treatment Failure and Return to In-Center Hemodialysis

David J Semple; Matthew Sypek; Shahid Ullah; Christopher Davies; Stephen McDonald

doi:10.1053/j.ajkd.2021.05.021

Mortality After Home Hemodialysis Treatment Failure and Return to In-Center Hemodialysis

Am J Kidney Dis. 2022 Jan;79(1):15-23.e1. doi: 10.1053/j.ajkd.2021.05.021. Epub 2021 Jul 16.

Authors

David J Semple¹, Matthew Sypek², Shahid Ullah³, Christopher Davies⁴, Stephen McDonald⁴

Affiliations

¹ Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. Electronic address: dsemple@adhb.govt.nz.
² ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
³ ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
⁴ ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.

PMID: 34274359
DOI: 10.1053/j.ajkd.2021.05.021

Abstract

Rationale & objective: Patients on home hemodialysis (HHD) may eventually return to in-center hemodialysis (ICHD) for clinical, technical, or psychosocial reasons. We studied the mortality of patients returning to ICHD after HHD, comparing it with the mortality experience among patients receiving HHD and patients receiving ICHD without prior treatment with HHD.

Study design: Retrospective cohort study.

Setting & participants: All patients represented in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) who commenced HD during 2005-2015 and were treated for >90 days.

Exposure: ICHD and/or HHD, and clinical characteristics at study entry.

Outcome: Mortality and cause of death.

Analytical approach: A time-varying multivariate Cox proportional hazards analysis with shared frailty was implemented to explore the association between patient treatment states and mortality. Patients were censored at the time of transplantation or change in treatment modality to peritoneal dialysis.

Results: A total of 19,306 patients initiated HD and were treated for >90 days. The mean age of patients was 60.8 ± 15.4 (SD) years, 62% were male, and 49% had diabetes. After HHD treatment failure, adjusted mortality was increased compared with continued HHD at 0-30 days (HR, 3.93 [95% CI, 2.09-7.40]; P < 0.001), 30-90 days (HR, 3.34 [95% CI, 1.98-5.62]; P < 0.001), and >90 days (HR, 2.29 [95% CI, 1.84-2.85]; P < 0.001).

Limitations: Covariates recorded at dialysis initiation, residual confounding underlying successful initiation of HHD treatment, and observational data lacking detail on cause of HHD treatment failure.

Conclusions: HHD treatment failure is associated with a significant increase in mortality compared with continued HHD. This risk was present in both the early (first 30 days and 30-90 days) and late (>90 days) periods after HHD treatment failure. Further investigation into the specific causes of treatment failure and death may highlight specific high-risk patients.

Keywords: End-stage kidney disease (ESKD); home hemodialysis (HHD); in-center hemodialysis (ICHD); modality change; mortality; treatment failure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Hemodialysis, Home*
Humans
Kidney Failure, Chronic* / therapy
Male
Middle Aged
Renal Dialysis
Retrospective Studies
Treatment Failure