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An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry).
Clin J Am Soc Nephrol. 2015 Aug 07; 10(8):1397-407.CJ

Abstract

BACKGROUND AND OBJECTIVES

Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model.

RESULTS

The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality.

CONCLUSIONS

Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis.

Authors+Show Affiliations

Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Medicine, Université de Montreal, Montreal, Canada;Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia;School of Medicine, University of Queensland, Brisbane, Australia;Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada;Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Sydney Medical School, University of Sydney, Sydney, Australia;Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Department of Nephrology, Monash Medical Centre, Monash Health, Clayton, Australia; Departments of Medicine, Epidemiology, and Preventative Medicine, Monash University, Melbourne, Australia; and.Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.Department of Medicine, Université de Montreal, Montreal, Canada;Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia; david.johnson2@health.qld.gov.au.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

26068181

Citation

Nadeau-Fredette, Annie-Claire, et al. "An Incident Cohort Study Comparing Survival On Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)." Clinical Journal of the American Society of Nephrology : CJASN, vol. 10, no. 8, 2015, pp. 1397-407.
Nadeau-Fredette AC, Hawley CM, Pascoe EM, et al. An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol. 2015;10(8):1397-407.
Nadeau-Fredette, A. C., Hawley, C. M., Pascoe, E. M., Chan, C. T., Clayton, P. A., Polkinghorne, K. R., Boudville, N., Leblanc, M., & Johnson, D. W. (2015). An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clinical Journal of the American Society of Nephrology : CJASN, 10(8), 1397-407. https://doi.org/10.2215/CJN.00840115
Nadeau-Fredette AC, et al. An Incident Cohort Study Comparing Survival On Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol. 2015 Aug 7;10(8):1397-407. PubMed PMID: 26068181.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry). AU - Nadeau-Fredette,Annie-Claire, AU - Hawley,Carmel M, AU - Pascoe,Elaine M, AU - Chan,Christopher T, AU - Clayton,Philip A, AU - Polkinghorne,Kevan R, AU - Boudville,Neil, AU - Leblanc,Martine, AU - Johnson,David W, Y1 - 2015/06/11/ PY - 2015/01/25/received PY - 2015/04/20/accepted PY - 2015/6/13/entrez PY - 2015/6/13/pubmed PY - 2016/5/11/medline KW - hemodialysis KW - peritoneal dialysis KW - survival SP - 1397 EP - 407 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 10 IS - 8 N2 - BACKGROUND AND OBJECTIVES: Home dialysis is often recognized as a first-choice therapy for patients initiating dialysis. However, studies comparing clinical outcomes between peritoneal dialysis and home hemodialysis have been very limited. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This Australia and New Zealand Dialysis and Transplantation Registry study assessed all Australian and New Zealand adult patients receiving home dialysis on day 90 after initiation of RRT between 2000 and 2012. The primary outcome was overall survival. The secondary outcomes were on-treatment survival, patient and technique survival, and death-censored technique survival. All results were adjusted with three prespecified models: multivariable Cox proportional hazards model (main model), propensity score quintile-stratified model, and propensity score-matched model. RESULTS: The study included 10,710 patients on incident peritoneal dialysis and 706 patients on incident home hemodialysis. Treatment with home hemodialysis was associated with better patient survival than treatment with peritoneal dialysis (5-year survival: 85% versus 44%, respectively; log-rank P<0.001). Using multivariable Cox proportional hazards analysis, home hemodialysis was associated with superior patient survival (hazard ratio for overall death, 0.47; 95% confidence interval, 0.38 to 0.59) as well as better on-treatment survival (hazard ratio for on-treatment death, 0.34; 95% confidence interval, 0.26 to 0.45), composite patient and technique survival (hazard ratio for death or technique failure, 0.34; 95% confidence interval, 0.29 to 0.40), and death-censored technique survival (hazard ratio for technique failure, 0.34; 95% confidence interval, 0.28 to 0.41). Similar results were obtained with the propensity score models as well as sensitivity analyses using competing risks models and different definitions for technique failure and lag period after modality switch, during which events were attributed to the initial modality. CONCLUSIONS: Home hemodialysis was associated with superior patient and technique survival compared with peritoneal dialysis. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/26068181/An_Incident_Cohort_Study_Comparing_Survival_on_Home_Hemodialysis_and_Peritoneal_Dialysis__Australia_and_New_Zealand_Dialysis_and_Transplantation_Registry__ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=26068181 DB - PRIME DP - Unbound Medicine ER -