BACKGROUND: There is increasing interest in the delivery of out-of-center hemodialysis (HD), particularly in the home setting, but little systematic information about its use and outcome in contemporary incident patients is available. PATIENTS AND METHODS: Out-of-center HD was defined as HD delivered in a residential setting, mainly at home or in a long-term care facility (such as a nursing home) irrespective of the length and frequency of therapy. All-cause mortality was determined in an observational cohort study of 458,329 adult patients initiating dialysis in the United States with Medicare as a primary payer. RESULTS: Between 1995 and 2004, out-of-center HD was the initial modality in 1,641 (0.4%) of eligible participants, although there was significant geographic variation. Patients initiating out-of-center HD were younger, more likely to be nonwhite, had fewer comorbidities, a higher median income, and were more likely to be employed than patients initiating in-center HD or peritoneal dialysis (PD). In multivariate analysis, out-of-center HD patients had a higher overall risk of death compared to in-center HD or PD patients (HR = 1.10, 95% CI 1.04, 1.17), although the relative risk of death was lower in younger and healthier patients (HR = 0.78; 95% CI 0.61, 1.00). CONCLUSION: Out-of-center HD is not associated with a survival advantage among unselected patients initiating dialysis in the United States. These results call for better characterization of out-of-center HD in national registries, primarily to effectively compare the use, outcomes and potential benefits of home HD to standard therapies.
BACKGROUND: There is increasing interest in the delivery of out-of-center hemodialysis (HD), particularly in the home setting, but little systematic information about its use and outcome in contemporary incident patients is available. PATIENTS AND METHODS: Out-of-center HD was defined as HD delivered in a residential setting, mainly at home or in a long-term care facility (such as a nursing home) irrespective of the length and frequency of therapy. All-cause mortality was determined in an observational cohort study of 458,329 adult patients initiating dialysis in the United States with Medicare as a primary payer. RESULTS: Between 1995 and 2004, out-of-center HD was the initial modality in 1,641 (0.4%) of eligible participants, although there was significant geographic variation. Patients initiating out-of-center HD were younger, more likely to be nonwhite, had fewer comorbidities, a higher median income, and were more likely to be employed than patients initiating in-center HD or peritoneal dialysis (PD). In multivariate analysis, out-of-center HDpatients had a higher overall risk of death compared to in-center HD or PDpatients (HR = 1.10, 95% CI 1.04, 1.17), although the relative risk of death was lower in younger and healthier patients (HR = 0.78; 95% CI 0.61, 1.00). CONCLUSION: Out-of-center HD is not associated with a survival advantage among unselected patients initiating dialysis in the United States. These results call for better characterization of out-of-center HD in national registries, primarily to effectively compare the use, outcomes and potential benefits of home HD to standard therapies.
Authors: Santhi K Ganesh; Tempie Hulbert-Shearon; Friedrich K Port; Kim Eagle; Austin G Stack Journal: J Am Soc Nephrol Date: 2003-02 Impact factor: 10.121
Authors: Carl M Kjellstrand; Umberto Buoncristiani; George Ting; Jules Traeger; Giordina B Piccoli; Roula Sibai-Galland; Bessie Ann Young; Christopher R Blagg Journal: Nephrol Dial Transplant Date: 2008-05-05 Impact factor: 5.992
Authors: Bertrand L Jaber; Fredric O Finkelstein; Joel D Glickman; Alan R Hull; Michael A Kraus; John K Leypoldt; Jiannong Liu; David Gilbertson; James McCarthy; Brent W Miller; John Moran; Allan J Collins Journal: Am J Kidney Dis Date: 2008-09-27 Impact factor: 8.860
Authors: R W Evans; D L Manninen; L P Garrison; L G Hart; C R Blagg; R A Gutman; A R Hull; E G Lowrie Journal: N Engl J Med Date: 1985-02-28 Impact factor: 91.245