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Original ArticlesMaintenance Dialysis
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Temporal Trends and Factors Associated with Home Hemodialysis Technique Survival in Canada

Jeffrey Perl, Yingbo Na, Karthik K. Tennankore and Christopher T. Chan
CJASN August 2017, 12 (8) 1248-1258; DOI: https://doi.org/10.2215/CJN.13271216
Jeffrey Perl
*Division of Nephrology and
†The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Ontario, Canada;
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Yingbo Na
*Division of Nephrology and
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Karthik K. Tennankore
‡Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada;
§Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
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Christopher T. Chan
‖Division of Nephrology, Department of Medicine, University of Toronto, University Health Network, Ontario, Canada
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Abstract

Background and objectives The last 15 years has seen growth in home hemodialysis (HD) utilization in Canada owing to reports of improved outcomes relative to patients on conventional in-center HD. What effect growth has had on home HD technique and patient survival during this period is not known.

Design, settings, participants, & measurements We compared the risk of home HD technique failure, mortality, and the composite outcome among three incident cohorts of patients on home HD in Canada: 1996–2002, 2003–2007, and 2008–2012. A multivariable piece-wise exponential model was used to evaluate all outcomes using inverse probability of treatment and censoring weights.

Results A total of 1869 incident patients on home HD were identified from the Canadian Organ Replacement Register. Relative to those treated between 2003 and 2007 (n=568), the risk of home HD technique failure was similar between patients treated between 1996 and 2002 (n=233; adjusted hazard ratio [AHR], 1.39; 95% confidence interval [95% CI], 0.78 to 2.46) but higher among incident patients on home HD treated between 2008 and 2012 (n=1068; AHR, 1.51; 95% CI, 1.06 to 2.15). Relative to patients treated between 2003 and 2007, adjusted mortality was similar among those treated between 2008 and 2012 (AHR, 0.83; 95% CI, 0.58 to 1.19) and those treated between 1996 and 2002 (AHR, 0.67; 95% CI, 0.38 to 1.21). The risk of the composite outcome of death and technique failure was similar across cohorts, as was the risk of receiving a kidney transplant. Increasing age, diabetes as a comorbidity, and smoking status were associated with an increased risk of death as well as the composite outcome. Medium-sized facilities had a lower risk of death, technique failure, and the composite outcome compared with larger facilities.

Conclusions A higher risk of technique failure was seen in the most contemporary era. Further characterization of the risk factors for, and causes of technique failure is needed to develop strategies to improve patient retention on home HD.

  • Hemodialysis
  • survival
  • technique survival
  • home hemodialysis
  • short daily hemodialysis
  • slow nocturnal hemodialysis
  • Canadian Organ Replacement Register
  • Technique Failure
  • Dialysis Modality Discontinuation
  • Home Dialysis Discontinuation
  • Canada
  • Comorbidity
  • Death
  • diabetes mellitus
  • Hemodialysis, Home
  • Humans
  • kidney transplantation
  • Proportional Hazards Models
  • risk factors
  • Smoking
  • Received December 28, 2016.
  • Accepted May 4, 2017.
  • Copyright © 2017 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 12 (8)
Clinical Journal of the American Society of Nephrology
Vol. 12, Issue 8
August 07, 2017
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Temporal Trends and Factors Associated with Home Hemodialysis Technique Survival in Canada
Jeffrey Perl, Yingbo Na, Karthik K. Tennankore, Christopher T. Chan
CJASN Aug 2017, 12 (8) 1248-1258; DOI: 10.2215/CJN.13271216

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Temporal Trends and Factors Associated with Home Hemodialysis Technique Survival in Canada
Jeffrey Perl, Yingbo Na, Karthik K. Tennankore, Christopher T. Chan
CJASN Aug 2017, 12 (8) 1248-1258; DOI: 10.2215/CJN.13271216
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Keywords

  • hemodialysis
  • survival
  • technique survival
  • home hemodialysis
  • short daily hemodialysis
  • slow nocturnal hemodialysis
  • Canadian Organ Replacement Register
  • Technique Failure
  • Dialysis Modality Discontinuation
  • Home Dialysis Discontinuation
  • Canada
  • Comorbidity
  • Death
  • diabetes mellitus
  • Hemodialysis, Home
  • Humans
  • kidney transplantation
  • Proportional Hazards Models
  • risk factors
  • Smoking

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