Home Hemodialysis Improves Dialysis Patients Survival

A new study reveals that more frequent home hemodialysis (HHD) provides significant improvements in first-year survival in renal dialysis patients across all age ranges.

The study, conducted by researchers at NxStage Medical (Lawrence, MA, USA), analyzed United States Renal Data System (USRDS) data for 557,139 incident dialysis patients who were prescribed more frequent HHD with the NxStage System One, or conventional in-center hemodialysis (IHD) therapy, shortly after dialysis initiation. The researchers estimated hazard ratios of death for HHD versus IHD, with adjustment for age, race, sex, primary cause of end-stage renal disease, comorbid conditions, vascular access type, body mass index (BMI), estimated glomerular filtration rate (eGFR), and hematocrit.

The results revealed that HHD patients were younger, more likely white, more likely male, less likely enrolled in Medicaid, and less likely to have heart failure (HF). Patients who initiated more frequent HHD showed improved survival, with a 23% lower risk of death versus IHD overall. The most striking results were found in patients in the 20-44 years age group, who experienced a 44% lower risk of death. The study was presented at the American Society of Nephrology (ASN) Kidney Week Conference, held during October 2018 in San Diego (CA, USA).

“Less than one percent of new dialysis patients each year perform home hemodialysis,” said lead author and study presenter Eric Weinhandl, PhD, clinical epidemiologist and biostatistician at NxStage. “44% lower risk of death is very meaningful, as younger dialysis patients have indicated that they place higher value on life expectancy. For young adults, maintaining both cardiovascular health and personal responsibilities and vocations are important, and increased hemodialysis frequency may be critical in improving both their clinical and quality of life outcomes.”

The NxStage System One is designed to deliver hemodialysis, hemofiltration, and/or ultrafiltration therapies to patients with renal failure or fluid overload. System features include a highly automated design with a drop-in cartridge to facilitate operation; high-quality premixed treatment fluids to enable fluid purity without relying on local water treatment; and wide operating ranges allow clinician flexibility in patient therapy prescriptions.

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