Associations with home hemodialysis modality failure and mortality

BACKGROUND: Limited data exist on risk factors for home hemodialysis (HH) failure and mortality. We sought to determine whether age, helper status, or ethnicity was associated with home dialysis failure or mortality. METHODS: We conducted a retrospective cohort study of all prevalent and incident patients from a regional dialysis unit who initiated HH training from December 2000 to September 2002. Baseline demographics, program entry and exit dates, and mortality were ascertained. Characteristics of those more likely to remain in the program were assessed using logistic regression; survival was determined using Cox proportional hazards models. RESULTS: Of the 1117 patients enrolled for dialysis, 116 patients were trained in the HH program (6.8%). Of those, 45.7% remained in the program, 10.3% received a transplant, 10.3% returned to in-center dialysis, 1.7% were lost to follow-up, and 31.7% expired. Compared to patients who returned to center or received a transplant, patients who remained on HH were more likely to be older, to have been on dialysis longer, and to have diabetes as their primary renal disease. Ethnicity, sex, or type of helper did not affect home program status. Among those who remained in the HH program, those with hypertension or other renal diseases had better survival than those with diabetes, as did those who had related helpers compared to those with unrelated helpers. CONCLUSIONS: Older and younger ages, but not ethnicity, helper status, or sex, were associated with home dialysis failure. Diabetes remained an independent risk factor for increased mortality. HH remains a viable option for many patients.