Survival with Intensive Home Hemodialysis Similar to Deceased Donor Kidney Transplantation

New Orleans—For patients with end-stage renal disease (ESRD), the treatment of choice is kidney transplantation; however, there is a shortage of available kidney donors. Results of a previous study in Canada suggested that intensive home hemodialysis had similar survival rates to that of recipients of deceased donor kidney transplantation. Angie G. Nishio-Luca, MD, and colleagues conducted a study in the same region in the United States to compare survival in a large cohort of patients treated with intensive home hemodialysis with recipients of kidney transplantation. Dr. Nichio-Luca reported study results during a poster session at Kidney Week 2017 in a poster titled Intensive Home Hemodialysis Survival is Comparable to Deceased Donor Kidney Transplant.

The cohort included all consecutive adult patients in the same region in Virginia who received a first kidney transplant or initiated intensive home hemodialysis between October 1997 and June 2014. Data on kidney transplantation were obtained from the Scientific Registry of Transplant Recipients; data on intensive home hemodialysis patients were obtained from Lynchburg Nephrology Physicians practice in Lynchburg, Virginia.

Exclusion criteria were recipients of en-bloc kidneys, multi-organ transplants, and subsequent kidney transplantation, as well as patients receiving other home dialysis therapies, in-center hemodialysis, or home hemodialysis of <20 hours per week or <4 sessions per week. Overall survival among different modalities was estimated using the Kaplan-Meier method: intensive home hemodialysis versus living donor transplant and intensive home hemodialysis versus deceased donor transplant. Multivariate Cox proportional hazard regression was used to estimated adjusted hazard ratios (HRs).

Following application of inclusion and exclusion criteria, the cohort included 3097 kidney transplant recipients and 116 intensive home hemodialysis patients. Baseline characteristics were similar in the two groups: females, 40.5% in the transplant group versus 41.4% in the dialysis group; 48.9% African Americans in the transplant group versus 50.9% in the dialysis group; and 36.5% with diabetes in the transplant group versus 37.1% in the transplant group. Patients in the intensive home hemodialysis group were more likely to be obese and have a history of malignancy than those in the transplantation group.

Patients in the living donor transplantation group had the highest patient survival. At 5 years, survival probability in the intensive home hemodialysis group was 79% (95% confidence interval [CI], 0.69-0.90) compared with 84% (95% CI, 0.82-0.86) in the deceased donor kidney transplantation group. Following adjustment for cause of ESRD, sex, age, and peripheral vascular disease, there was no significant difference in the hazard ratios between the intensive home hemodialysis group and the deceased donor transplant group (HR, 1.05; 95% CI, 0.68-1.62; P=.837).

In conclusion, the researchers said, “In this study, survival of intensive home hemodialysis patients was not statistically different from deceased donor kidney transplantation, suggesting intensive home hemodialysis could be a reasonable alternative to deceased donor kidney transplantation.”

Source: Nishio-Lucar AG, Lyons GR, Bose S, Lockridge RS. Intensive home hemodialysis survival is comparable to deceased donor kidney transplant. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 3, 2017, New Orleans, Louisiana