Outcomes on home haemodialysis: registry challenges

Area of Science:

• Nephrology and Public Health
• Renal Replacement Therapy

Background:

• Healthcare policies increasingly support home hemodialysis (HHD) to enhance patient outcomes and decrease costs.
• Existing patient outcome data for HHD primarily stem from retrospective observational studies, which have limitations.
• The mechanisms behind the observed mortality reductions with HHD require further investigation.

Purpose of the Study:

• To analyze the impact of different HHD modalities on patient outcomes, particularly mortality.
• To explore the reasons for improved outcomes in HHD compared to conventional treatments.
• To discuss strategies for enhancing the quality of future HHD observational studies and consider non-mortality outcomes.

Main Methods:

• Review and analysis of existing retrospective observational studies on home hemodialysis.
• Comparison of mortality rates between conventional thrice-weekly HHD, frequent/nocturnal HHD, and deceased donor kidney transplantation.
• Discussion of methodological approaches to improve future study designs and consideration of patient-relevant, non-mortality endpoints.

Main Results:

• Conventional thrice-weekly HHD is associated with a 22-51% reduction in mortality.
• Frequent and/or nocturnal HHD demonstrates a significant 36-66% reduction in mortality.
• Outcomes with frequent/nocturnal HHD are comparable to those of deceased donor kidney transplantation.

Conclusions:

• Home hemodialysis, especially frequent or nocturnal regimens, offers substantial survival benefits.
• HHD outcomes rival those of kidney transplantation, highlighting its potential as a primary renal replacement therapy.
• Improvements in study design and focus on diverse patient-relevant outcomes are crucial for future research in HHD.