Original ArticlesMaintenance Dialysis

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

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Tables

  • Table 1.

    Patient characteristics at home hemodialysis initiation in Canada during the period 1996–2012

    VariableYr of Dialysis InitiationP Value
    1996–2002 (n=233)2003–2007 (n=568)2008–2012 (n=1068)
    Age, yr, mean±SD49±1352±1453±14<0.001
    Race, n (%)
     White175 (75)392 (69)740 (69)0.001
     Asian9 (4)49 (9)63 (6)
     Black12 (5)25 (4)71 (7)
     Other15 (6)61 (11)139 (13)
     Unknown22 (9)41 (7)55 (5)
    Women, %72 (31)182 (32)374 (35)0.2
    Primary diagnosis, n (%)
     GN48 (21)109 (19)176 (17)0.01
     Diabetes49 (21)119 (21)292 (27)
     Renal vascular disease23 (10)69 (12)111 (10)
     Polycystic kidney disease37 (16)57 (10)120 (11)
     Failed kidney transplant8 (3)41 (7)83 (8)
     Other45 (19)99 (17)175 (16)
     Unknown23 (10)74 (13)111 (10)
    Comorbid conditions, n (%)
     Diabetesa12(5)37 (7)97 (9)0.05
     Coronary artery disease84 (36)174 (31)281 (26)0.04
     Peripheral vascular disease24 (10)49 (9)69 (7)0.07
     Previous CVA14 (6)27 (5)58 (5)0.6
     Smokerb24 (10)46 (8)108 (10)0.4
    Vascular access type, n (%)c
     AV access50 (22)214 (38)458 (43)<0.001
     CVC24 (10)149(26)415(39)
     Unknownc159 (68)205 (36)195 (18)
    BMI, median (IQR), kg/m225.1 (22.5–29.6)26.6 (22.7–31.5)27.9 (23.8–33.7)<0.001
    ESRD vintage, yr, median (IQR)0.8 (0.3–1.9)1.3 (0.3–3.1)0.9 (0.2–3.1)0.003
    Prior RRT, n (%)
     None7 (3)50 (9)113 (11)<0.01
     In-center HD207 (89)487 (86)880 (82)
     PD18 (8)24 (4)65 (6)
     Kidney transplant1 (0.4)7 (1)10 (1)
    Facility size n (%)
     Small (≤1–4 patients)34 (15)23 (4)47 (4)<0.001
     Medium (5–9 patients)68 (29)93 (16)240 (23)
     Large (≥9 patients)131 (56)452 (80)781 (73)
    Home hemodialysis modality, n (%)
     Conventional181 (78)216 (38)532 (50)<0.001
     Short daily5 (2)104 (18)166 (16)
     Slow nocturnal47 (20)248 (44)370 (35)
    Neighborhood income quintile, n (%)
     143 (19)73 (13)156 (15)0.02
     241 (18)96 (17)180 (17)
     349 (21)124 (22)213 (20)
     429 (12)132 (23)257 (24)
     563 (27)134 (24)244 (23)
     Unknown8 (3)9 (2)18 (2)
    Distance (in km) from the dialysis facility, n (%)
     <15109 (47)260 (46)536 (50)0.06
     15–2520 (9)67 (12)146 (14)
     25–5030 (13)78 (14)145 (14)
     50–7513 (6)35 (6)52 (5)
     75–10014 (6)35 (6)39 (4)
     >10040 (17)86 (15)133 (13)
     Unknown7 (3)7 (1)17 (2)

    • CVA, cerebrovascular accident; AV, arteriovenous; CVC, central venous catheter; BMI, body mass index; IQR, interquartile range.

    • ↵a Diabetes as a comorbidity among those without presumed kidney disease.

    • ↵b Smoking status at ESRD initiation.

    • ↵c Data on vascular access type were not collected until 2001.

  • Table 2.

    Associations of era of home hemodialysis initiation with all-cause mortality, technique failure, and the composite of death and technique failure

    DeathTechnique FailureDeath and Technique Failure
    Incident Cohort PeriodEventsEvent Rates/100 Patient-YrEventsEvent Rates/100 Patient-YrEventsEvent Rates/100 Patient-Yr
    1996–2002517.37412.012519.3
    2003–2007 (ref)1277.91589.528517.4
    2008–2012915.527116.836222.3
    Unadjusted Hazard Ratio (95% CI)
    Overall
     1996–20020.94 (0.68 to 1.31)1.10 (0.93 to 1.45)1.03 (0.83 to 1.27)
     2003–2007 (ref)111
     2008–20120.75 (0.56 to 0.99)1.51 (1.23 to 1.86)1.19 (1.01 to 1.40)
    Adjusted Hazard Ratio (95% CI)
    Overalla
     1996–20020.67 (0.38 to 1.21)1.39 (0.78 to 2.46)1.11 (0.71 to 1.74)
     2003–2007 (ref)111
     2008–20120.83 (0.58 to 1.19)1.51 (1.06 to 2.15)1.25 (0.98 to 1.61)
    Yr 1a
     1996–20020.67 (0.31 to 1.49)1.49 (0.69 to 3.21)1.19 (0.62 to 2.26)
     2003–2007 (ref)111
     2008–20120.71 (0.43 to 1.20)2.45 (1.78 to 3.39)1.84 (1.41 to 2.38)

    • ref, referent group; 95% CI, 95% confidence interval.

    • ↵a Adjusted for age, sex, race, body mass, vascular access type, dialysis vintage, home hemodialysis modality, region, facility size, distance, income quintile, primary diagnosis, diabetes, coronary artery disease, stroke, peripheral vascular disease, and smoking status.

  • Table 3.

    Associations of additional covariates with all-cause mortality, technique failure, and the composite of death and technique failure

    VariableDeathTechnique FailureDeath and Technique Failure
    No. of events269503772
    AHR (95% CI)AHR (95% CI)AHR (95% CI)
    Age, yr
     18–34 (ref)111
     35–543.40 (1.3 to 8.6)1.0 (0.65 to 1.56)1.17 (0.79 to 1.73)
     55–645.90 (2.30 to 15)1.09 (0.68 to 1.76)1.49 (0.99 to 2.3)
     65–746.40 (2.40 to 16.9)2.34 (1.43 to 3.9)2.57 (1.65 to 3.99)
     >7516.5 (6.10 to 44.70)1.47 (0.79 to 2.74)2.71 (1.70 to 4.3)
    Race
     White (ref)111
     Asian1.18 (0.60 to 2.30)0.88 (0.51 to 1.50)0.96 (0.64 to 1.43)
     Black1.90 (0.75 to 4.80)1.47 (0.87 to 2.49)1.49 (0.92 to 2.30)
     Other0.72 (0.41 to 1.29)1.70 (1.16 to 2.50)1.43 (1.01 to 2.02)
    Men1.1 (0.76 to 1.50)0.85 (0.66 to 1.10)0.91 (0.73 to 1.13)
    Primary diagnosis
     GN0.23 (0.12 to 0.45)0.60 (0.39 to 0.93)0.48 (0.33 to 0.69)
     Diabetes111
     Renovascular disease0.37 (0.21 to 0.65)0.89 (0.60 to 1.34)0.70 (0.51 to 0.97)
     Polycystic kidney disease0.15 (0.06 to 0.38)0.58 (0.35 to 0.97)0.42 (0.27 to 0.66)
     Failed kidney transplant0.37 (0.13 to 1.04)0.53 (0.27 to 1.06)0.47 (0.26 to 0.83)
     Other0.40 (0.23 to 0.70)0.99 (0.67 to 1.48)0.79 (0.57 to 1.10)
    Comorbid conditions
     Diabetes2.7 (1.60 to 4.40)1.23 (0.80 to 1.9)1.54 (1.1 to 2.14)
     CADa1.2 (0.80 to 1.70)0.95 (0.67 to 1.36)1.02 (0.79 to 1.33)
     PVD2.0 (1.30 to 3.10)1.0 (0.65 to 1.58)1.39 (1.03 to 1.88)
     Previous CVA1.0 (0.60 to 1.70)1.24 (0.58 to 2.67)1.14 (0.67 to 1.94)
     Current smokera1.8 (0.99 to 3.40)1.62 (1.17 to 2.25)1.67 (1.27 to 2.21)
    Vascular access type
     AV access0.46 (0.29 to 0.71)0.76 (0.52 to 1.10)0.65 (0.48 to 0.87)
     CVC (ref)111
    Body mass index, kg/m2
     <18.50.89 (0.4 to 1.97)0.70 (0.26 to 1.89)0.71 (0.36 to 1.38)
     18.5–24.9 (ref)111
     25–29.90.64 (0.40 to 1.00)1.06 (0.73 to 1.54)0.91 (0.68 to 1.22)
     ≥300.74 (0.43 to 1.38)1.16 (0.83 to 1.60)1.03 (0.79 to 1.34)
    ESRD vintage, per yr1.1 (0.99 to 1.18)1.04 (0.99 to 1.10)1.05 (1.01 to 1.10)
    Prior RRT
     None0.52 (0.18 to 1.44)2.09 (1.1 to 3.97)1.55 (0.88 to 2.73)
     In-center hemodialysis111
     PD0.82 (0.41 to 1.66)0.70 (0.41 to 1.19)0.76 (0.49 to 1.17)
     Kidney transplant0.26 (0.03 to 2.30)0.29 (0.04 to 2.39)0.29 (0.06 to 1.42)
    Facility size
     Small (1–4)0.31 (0.12 to 0.82)0.74 (0.39 to 1.43)0.60 (0.33 to 1.08)
     Medium (5–9)0.64 (0.41 to 1.00)0.66 (0.45 to 0.96)0.63 (0.47 to 0.85)
     Large (>9)111
    Home hemodialysis modality
     Conventional111
     Short daily0.69 (0.40 to 1.19)1.09 (0.77 to 1.05)0.97 (0.72 to 1.30)
     Slow nocturnal1.03 (0.66 to 1.59)0.99 (0.70 to 1.42)0.98 (0.74 to 1.30)
    Neighborhood income quintile (per quintile increase)0.94 (0.82 to 1.08)0.89 (0.81 to 0.97)0.90 (0.83 to 0.97)
    Distance from the dialysis facility, km
     <15111
     15–250.87 (0.51 to 1.49)0.74 (0.50 to 1.09)0.75 (0.55 to 1.04)
     26–500.64 (0.35 to 1.16)0.54 (0.34 to 0.85)0.55 (0.37 to 0.80)
     51–751.6 (0.85 to 3.05)0.54 (0.27 to 1.09)0.74 (0.46 to 1.21)
     76–1001.04 (0.51 to 2.10)1.32 (0.83 to 2.10)1.25 (0.83 to 1.88)
     >1001.16 (0.68 to 1.96)0.72 (0.48 to 1.05)0.82 (0.61 to 1.10)

    • AHR, adjusted hazard ratio; 95% CI, 95% confidence interval; ref, referent group; CAD, coronary artery disease; PVD, peripheral vascular disease; CVA, cerebrovascular accident; AV, arteriovenous; CVC, central venous catheter; PD, peritoneal dialysis.

    • ↵a All models adjusted for age, sex, race, body mass, vascular access type, dialysis vintage, home hemodialysis modality, region, facility size, distance, income quintile, primary diagnosis, diabetes, coronary artery disease, stroke, peripheral vascular disease, and smoking status.

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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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