Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada

Annie Claire Nadeau-Fredette; Karthik K. Tennankore; Jeffrey Perl; Joanne M. Bargman; David W. Johnson; Christopher T. Chan

doi:10.1016/j.ekir.2020.08.020

Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada

Annie Claire Nadeau-Fredette, Karthik K. Tennankore, Jeffrey Perl, Joanne M. Bargman, David W. Johnson, Christopher T. Chan

Medicine

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

Abstract

Introduction: As interest for home dialysis is growing, knowledge of comparative clinical outcomes between peritoneal dialysis (PD) and home hemodialysis (HHD) would help to better inform shared decision making with patients and caregivers during modality discussion. This study aimed to assess differences in risk of mortality and technique failure in an incident home dialysis cohort and, specifically, to assess change in this association through eras. Methods: All adults patients initiating PD or HHD, in Canada (excluding Quebec), within 365 days after kidney replacement therapy (KRT) initiation between 2000 and 2013 were included (administrative censoring 31 December 2014). Mortality and treatment failure (transfer to another modality for >90 days or death) were assessed in a multivariable Cox proportional hazard model, with prespecified stratification based on the year of KRT initiation. Results: The study included 959 HHD and 15,469 PD patients. Compared with incident PD, incident HHD was associated with a lower risk of mortality (adjusted hazard ratio [aHR] = 0.64, 95% confidence interval [CI] = 0.53−0.78), and treatment failure (aHR = 0.52, 95% CI = 0.45−0.60). These lower risks of mortality with HHD were more pronounced for older cohorts (2000−2005: aHR = 0.47, 95% CI = 0.31−0.70; 2006−2010: aHR = 0.70, 95% CI = 0.54−0.89) and not significantly different in the most recent era (2011−2013: aHR = 0.86, 95% CI = 0.51−1.47). Conclusion: In Canadian incident KRT patients, HHD was associated with appreciably lower risks of mortality and treatment failure compared to PD, although this association appeared to be attenuated in the most contemporary era.

Original language	English
Pages (from-to)	1965-1973
Number of pages	9
Journal	Kidney International Reports
Volume	5
Issue number	11
DOIs	https://doi.org/10.1016/j.ekir.2020.08.020
Publication status	Published - Nov 2020

Bibliographical note

Funding Information:
ACN-F has a scholarship from Les Fonds de la Recherche du Québec en Santé (FRQS) and has received previous speaker honoraria from Baxter and previous investigator-initiated grant support Baxter CEC grant. KKT, not relevant to the current submission, has received unrestricted grant funding from Otsuka, Canada and Astellas, Canada for investigator-initiated research projects, and has attended Advisory Boards for Otsuka, Astra-Zeneca, Baxter, and Janssen. JP has consulted for Baxter Healthcare, DaVita, and liberDi and has received speaker honoraria from Astra Zeneca, Baxter International, DaVita Healthcare partners, Dialysis Clinic Inc., Satellite Healthcare, and Fresenius Medical Care. JMB has been a Consultant for Baxter Canada and DaVita Healthcare Partners. DWJ has received personal fees from AWAK, Astra-Zeneca, Ono, Baxter Healthcare, and Fresenius Medical Care, and grant support from Baxter Extramural and Baxter CEC Grants. CT Chan holds the R Fraser Elliott Chair in Home Dialysis and has consulted for Baxter, Medtronic, and NxStage. He has also received investigator-initiated grant support from Baxter CEC grant program and Medtronic ERP program.

Publisher Copyright:
© 2020 International Society of Nephrology

ASJC Scopus Subject Areas

Nephrology

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10.1016/j.ekir.2020.08.020

Cite this

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title = "Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada",

abstract = "Introduction: As interest for home dialysis is growing, knowledge of comparative clinical outcomes between peritoneal dialysis (PD) and home hemodialysis (HHD) would help to better inform shared decision making with patients and caregivers during modality discussion. This study aimed to assess differences in risk of mortality and technique failure in an incident home dialysis cohort and, specifically, to assess change in this association through eras. Methods: All adults patients initiating PD or HHD, in Canada (excluding Quebec), within 365 days after kidney replacement therapy (KRT) initiation between 2000 and 2013 were included (administrative censoring 31 December 2014). Mortality and treatment failure (transfer to another modality for >90 days or death) were assessed in a multivariable Cox proportional hazard model, with prespecified stratification based on the year of KRT initiation. Results: The study included 959 HHD and 15,469 PD patients. Compared with incident PD, incident HHD was associated with a lower risk of mortality (adjusted hazard ratio [aHR] = 0.64, 95% confidence interval [CI] = 0.53−0.78), and treatment failure (aHR = 0.52, 95% CI = 0.45−0.60). These lower risks of mortality with HHD were more pronounced for older cohorts (2000−2005: aHR = 0.47, 95% CI = 0.31−0.70; 2006−2010: aHR = 0.70, 95% CI = 0.54−0.89) and not significantly different in the most recent era (2011−2013: aHR = 0.86, 95% CI = 0.51−1.47). Conclusion: In Canadian incident KRT patients, HHD was associated with appreciably lower risks of mortality and treatment failure compared to PD, although this association appeared to be attenuated in the most contemporary era.",

author = "Nadeau-Fredette, {Annie Claire} and Tennankore, {Karthik K.} and Jeffrey Perl and Bargman, {Joanne M.} and Johnson, {David W.} and Chan, {Christopher T.}",

note = "Funding Information: ACN-F has a scholarship from Les Fonds de la Recherche du Qu{\'e}bec en Sant{\'e} (FRQS) and has received previous speaker honoraria from Baxter and previous investigator-initiated grant support Baxter CEC grant. KKT, not relevant to the current submission, has received unrestricted grant funding from Otsuka, Canada and Astellas, Canada for investigator-initiated research projects, and has attended Advisory Boards for Otsuka, Astra-Zeneca, Baxter, and Janssen. JP has consulted for Baxter Healthcare, DaVita, and liberDi and has received speaker honoraria from Astra Zeneca, Baxter International, DaVita Healthcare partners, Dialysis Clinic Inc., Satellite Healthcare, and Fresenius Medical Care. JMB has been a Consultant for Baxter Canada and DaVita Healthcare Partners. DWJ has received personal fees from AWAK, Astra-Zeneca, Ono, Baxter Healthcare, and Fresenius Medical Care, and grant support from Baxter Extramural and Baxter CEC Grants. CT Chan holds the R Fraser Elliott Chair in Home Dialysis and has consulted for Baxter, Medtronic, and NxStage. He has also received investigator-initiated grant support from Baxter CEC grant program and Medtronic ERP program. Publisher Copyright: {\textcopyright} 2020 International Society of Nephrology",

year = "2020",

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doi = "10.1016/j.ekir.2020.08.020",

language = "English",

volume = "5",

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journal = "Kidney International Reports",

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publisher = "Elsevier Inc.",

number = "11",

}

TY - JOUR

T1 - Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada

AU - Nadeau-Fredette, Annie Claire

AU - Tennankore, Karthik K.

AU - Perl, Jeffrey

AU - Bargman, Joanne M.

AU - Johnson, David W.

AU - Chan, Christopher T.

N1 - Funding Information: ACN-F has a scholarship from Les Fonds de la Recherche du Québec en Santé (FRQS) and has received previous speaker honoraria from Baxter and previous investigator-initiated grant support Baxter CEC grant. KKT, not relevant to the current submission, has received unrestricted grant funding from Otsuka, Canada and Astellas, Canada for investigator-initiated research projects, and has attended Advisory Boards for Otsuka, Astra-Zeneca, Baxter, and Janssen. JP has consulted for Baxter Healthcare, DaVita, and liberDi and has received speaker honoraria from Astra Zeneca, Baxter International, DaVita Healthcare partners, Dialysis Clinic Inc., Satellite Healthcare, and Fresenius Medical Care. JMB has been a Consultant for Baxter Canada and DaVita Healthcare Partners. DWJ has received personal fees from AWAK, Astra-Zeneca, Ono, Baxter Healthcare, and Fresenius Medical Care, and grant support from Baxter Extramural and Baxter CEC Grants. CT Chan holds the R Fraser Elliott Chair in Home Dialysis and has consulted for Baxter, Medtronic, and NxStage. He has also received investigator-initiated grant support from Baxter CEC grant program and Medtronic ERP program. Publisher Copyright: © 2020 International Society of Nephrology

PY - 2020/11

Y1 - 2020/11

N2 - Introduction: As interest for home dialysis is growing, knowledge of comparative clinical outcomes between peritoneal dialysis (PD) and home hemodialysis (HHD) would help to better inform shared decision making with patients and caregivers during modality discussion. This study aimed to assess differences in risk of mortality and technique failure in an incident home dialysis cohort and, specifically, to assess change in this association through eras. Methods: All adults patients initiating PD or HHD, in Canada (excluding Quebec), within 365 days after kidney replacement therapy (KRT) initiation between 2000 and 2013 were included (administrative censoring 31 December 2014). Mortality and treatment failure (transfer to another modality for >90 days or death) were assessed in a multivariable Cox proportional hazard model, with prespecified stratification based on the year of KRT initiation. Results: The study included 959 HHD and 15,469 PD patients. Compared with incident PD, incident HHD was associated with a lower risk of mortality (adjusted hazard ratio [aHR] = 0.64, 95% confidence interval [CI] = 0.53−0.78), and treatment failure (aHR = 0.52, 95% CI = 0.45−0.60). These lower risks of mortality with HHD were more pronounced for older cohorts (2000−2005: aHR = 0.47, 95% CI = 0.31−0.70; 2006−2010: aHR = 0.70, 95% CI = 0.54−0.89) and not significantly different in the most recent era (2011−2013: aHR = 0.86, 95% CI = 0.51−1.47). Conclusion: In Canadian incident KRT patients, HHD was associated with appreciably lower risks of mortality and treatment failure compared to PD, although this association appeared to be attenuated in the most contemporary era.

AB - Introduction: As interest for home dialysis is growing, knowledge of comparative clinical outcomes between peritoneal dialysis (PD) and home hemodialysis (HHD) would help to better inform shared decision making with patients and caregivers during modality discussion. This study aimed to assess differences in risk of mortality and technique failure in an incident home dialysis cohort and, specifically, to assess change in this association through eras. Methods: All adults patients initiating PD or HHD, in Canada (excluding Quebec), within 365 days after kidney replacement therapy (KRT) initiation between 2000 and 2013 were included (administrative censoring 31 December 2014). Mortality and treatment failure (transfer to another modality for >90 days or death) were assessed in a multivariable Cox proportional hazard model, with prespecified stratification based on the year of KRT initiation. Results: The study included 959 HHD and 15,469 PD patients. Compared with incident PD, incident HHD was associated with a lower risk of mortality (adjusted hazard ratio [aHR] = 0.64, 95% confidence interval [CI] = 0.53−0.78), and treatment failure (aHR = 0.52, 95% CI = 0.45−0.60). These lower risks of mortality with HHD were more pronounced for older cohorts (2000−2005: aHR = 0.47, 95% CI = 0.31−0.70; 2006−2010: aHR = 0.70, 95% CI = 0.54−0.89) and not significantly different in the most recent era (2011−2013: aHR = 0.86, 95% CI = 0.51−1.47). Conclusion: In Canadian incident KRT patients, HHD was associated with appreciably lower risks of mortality and treatment failure compared to PD, although this association appeared to be attenuated in the most contemporary era.

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Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada

Abstract

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