Correlates of decade-long technique survival on home hemodialysis

Since initiating home hemodialysis 20 years ago, the authors have successfully trained 192 selected patients who began self dialysis at home. Of these, 36 patients (19%) have continued uninterrupted home hemodialysis for 10 or more years (mean 14 years). To ascertain which factors might predict long duration on home hemodialysis these 36 long-term patients (LT) were compared to the entire group (all). Mean age at initiation of dialysis was 36 years in LT and 40 years in all. There was no significant difference in gender between LT and all. A significantly greater (p less than 0.01) proportion of LT (72%) were white compared with the whole group (53%). Seventy-eight percent of LT were middle class while 67% of the entire group were middle class (p less than 0.05). Renal diagnosis in LT were glomerulonephritis in ten (28%) polycystic kidney disease in eight (22%) congenital and/or infectious renal disease in eight (22%), miscellaneous or unknown in the rest. Hereditary disease thus accounted for 36% of all LT. Twenty-four LT remain on home hemodialysis, four returned to center dialysis and nine died. The authors conclude that 1) Home hemodialysis for a decade or longer is not rare in selected patients. 2) White, middle class men remain on home hemodialysis the longest. Although declining in popularity, this treatment modality proffers survival advantage for appropriately chosen individuals.