Home Hemodialysis and Peritoneal Dialysis Patient and Technique Survival in Canada

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.