Article Figures & Data
Figures
- Figure 1.
Direct adjusted patient survival, technique survival, and the composite of patient and technique survival among patients on home hemodialysis demonstrating a higher risk of technique failure in the 2008–2012 cohort relative to the 2003–2007 cohort. (A) Patient survival, (B) technique survival, and (C) patient and technique survival. 95% CI, 95% confidence interval; HHD, home hemodialysis.
Tables
- Table 1.
Patient characteristics at home hemodialysis initiation in Canada during the period 1996–2012
Variable Yr of Dialysis Initiation P Value 1996–2002 (n=233) 2003–2007 (n=568) 2008–2012 (n=1068) Age, yr, mean±SD 49±13 52±14 53±14 <0.001 Race, n (%) White 175 (75) 392 (69) 740 (69) 0.001 Asian 9 (4) 49 (9) 63 (6) Black 12 (5) 25 (4) 71 (7) Other 15 (6) 61 (11) 139 (13) Unknown 22 (9) 41 (7) 55 (5) Women, % 72 (31) 182 (32) 374 (35) 0.2 Primary diagnosis, n (%) GN 48 (21) 109 (19) 176 (17) 0.01 Diabetes 49 (21) 119 (21) 292 (27) Renal vascular disease 23 (10) 69 (12) 111 (10) Polycystic kidney disease 37 (16) 57 (10) 120 (11) Failed kidney transplant 8 (3) 41 (7) 83 (8) Other 45 (19) 99 (17) 175 (16) Unknown 23 (10) 74 (13) 111 (10) Comorbid conditions, n (%) Diabetesa 12(5) 37 (7) 97 (9) 0.05 Coronary artery disease 84 (36) 174 (31) 281 (26) 0.04 Peripheral vascular disease 24 (10) 49 (9) 69 (7) 0.07 Previous CVA 14 (6) 27 (5) 58 (5) 0.6 Smokerb 24 (10) 46 (8) 108 (10) 0.4 Vascular access type, n (%)c AV access 50 (22) 214 (38) 458 (43) <0.001 CVC 24 (10) 149(26) 415(39) Unknownc 159 (68) 205 (36) 195 (18) BMI, median (IQR), kg/m2 25.1 (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 (%) None 7 (3) 50 (9) 113 (11) <0.01 In-center HD 207 (89) 487 (86) 880 (82) PD 18 (8) 24 (4) 65 (6) Kidney transplant 1 (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 (%) Conventional 181 (78) 216 (38) 532 (50) <0.001 Short daily 5 (2) 104 (18) 166 (16) Slow nocturnal 47 (20) 248 (44) 370 (35) Neighborhood income quintile, n (%) 1 43 (19) 73 (13) 156 (15) 0.02 2 41 (18) 96 (17) 180 (17) 3 49 (21) 124 (22) 213 (20) 4 29 (12) 132 (23) 257 (24) 5 63 (27) 134 (24) 244 (23) Unknown 8 (3) 9 (2) 18 (2) Distance (in km) from the dialysis facility, n (%) <15 109 (47) 260 (46) 536 (50) 0.06 15–25 20 (9) 67 (12) 146 (14) 25–50 30 (13) 78 (14) 145 (14) 50–75 13 (6) 35 (6) 52 (5) 75–100 14 (6) 35 (6) 39 (4) >100 40 (17) 86 (15) 133 (13) Unknown 7 (3) 7 (1) 17 (2) - Table 2.
Associations of era of home hemodialysis initiation with all-cause mortality, technique failure, and the composite of death and technique failure
Death Technique Failure Death and Technique Failure Incident Cohort Period Events Event Rates/100 Patient-Yr Events Event Rates/100 Patient-Yr Events Event Rates/100 Patient-Yr 1996–2002 51 7.3 74 12.0 125 19.3 2003–2007 (ref) 127 7.9 158 9.5 285 17.4 2008–2012 91 5.5 271 16.8 362 22.3 Unadjusted Hazard Ratio (95% CI) Overall 1996–2002 0.94 (0.68 to 1.31) 1.10 (0.93 to 1.45) 1.03 (0.83 to 1.27) 2003–2007 (ref) 1 1 1 2008–2012 0.75 (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 1996–2002 0.67 (0.38 to 1.21) 1.39 (0.78 to 2.46) 1.11 (0.71 to 1.74) 2003–2007 (ref) 1 1 1 2008–2012 0.83 (0.58 to 1.19) 1.51 (1.06 to 2.15) 1.25 (0.98 to 1.61) Yr 1a 1996–2002 0.67 (0.31 to 1.49) 1.49 (0.69 to 3.21) 1.19 (0.62 to 2.26) 2003–2007 (ref) 1 1 1 2008–2012 0.71 (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
Variable Death Technique Failure Death and Technique Failure No. of events 269 503 772 AHR (95% CI) AHR (95% CI) AHR (95% CI) Age, yr 18–34 (ref) 1 1 1 35–54 3.40 (1.3 to 8.6) 1.0 (0.65 to 1.56) 1.17 (0.79 to 1.73) 55–64 5.90 (2.30 to 15) 1.09 (0.68 to 1.76) 1.49 (0.99 to 2.3) 65–74 6.40 (2.40 to 16.9) 2.34 (1.43 to 3.9) 2.57 (1.65 to 3.99) >75 16.5 (6.10 to 44.70) 1.47 (0.79 to 2.74) 2.71 (1.70 to 4.3) Race White (ref) 1 1 1 Asian 1.18 (0.60 to 2.30) 0.88 (0.51 to 1.50) 0.96 (0.64 to 1.43) Black 1.90 (0.75 to 4.80) 1.47 (0.87 to 2.49) 1.49 (0.92 to 2.30) Other 0.72 (0.41 to 1.29) 1.70 (1.16 to 2.50) 1.43 (1.01 to 2.02) Men 1.1 (0.76 to 1.50) 0.85 (0.66 to 1.10) 0.91 (0.73 to 1.13) Primary diagnosis GN 0.23 (0.12 to 0.45) 0.60 (0.39 to 0.93) 0.48 (0.33 to 0.69) Diabetes 1 1 1 Renovascular disease 0.37 (0.21 to 0.65) 0.89 (0.60 to 1.34) 0.70 (0.51 to 0.97) Polycystic kidney disease 0.15 (0.06 to 0.38) 0.58 (0.35 to 0.97) 0.42 (0.27 to 0.66) Failed kidney transplant 0.37 (0.13 to 1.04) 0.53 (0.27 to 1.06) 0.47 (0.26 to 0.83) Other 0.40 (0.23 to 0.70) 0.99 (0.67 to 1.48) 0.79 (0.57 to 1.10) Comorbid conditions Diabetes 2.7 (1.60 to 4.40) 1.23 (0.80 to 1.9) 1.54 (1.1 to 2.14) CADa 1.2 (0.80 to 1.70) 0.95 (0.67 to 1.36) 1.02 (0.79 to 1.33) PVD 2.0 (1.30 to 3.10) 1.0 (0.65 to 1.58) 1.39 (1.03 to 1.88) Previous CVA 1.0 (0.60 to 1.70) 1.24 (0.58 to 2.67) 1.14 (0.67 to 1.94) Current smokera 1.8 (0.99 to 3.40) 1.62 (1.17 to 2.25) 1.67 (1.27 to 2.21) Vascular access type AV access 0.46 (0.29 to 0.71) 0.76 (0.52 to 1.10) 0.65 (0.48 to 0.87) CVC (ref) 1 1 1 Body mass index, kg/m2 <18.5 0.89 (0.4 to 1.97) 0.70 (0.26 to 1.89) 0.71 (0.36 to 1.38) 18.5–24.9 (ref) 1 1 1 25–29.9 0.64 (0.40 to 1.00) 1.06 (0.73 to 1.54) 0.91 (0.68 to 1.22) ≥30 0.74 (0.43 to 1.38) 1.16 (0.83 to 1.60) 1.03 (0.79 to 1.34) ESRD vintage, per yr 1.1 (0.99 to 1.18) 1.04 (0.99 to 1.10) 1.05 (1.01 to 1.10) Prior RRT None 0.52 (0.18 to 1.44) 2.09 (1.1 to 3.97) 1.55 (0.88 to 2.73) In-center hemodialysis 1 1 1 PD 0.82 (0.41 to 1.66) 0.70 (0.41 to 1.19) 0.76 (0.49 to 1.17) Kidney transplant 0.26 (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) 1 1 1 Home hemodialysis modality Conventional 1 1 1 Short daily 0.69 (0.40 to 1.19) 1.09 (0.77 to 1.05) 0.97 (0.72 to 1.30) Slow nocturnal 1.03 (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 <15 1 1 1 15–25 0.87 (0.51 to 1.49) 0.74 (0.50 to 1.09) 0.75 (0.55 to 1.04) 26–50 0.64 (0.35 to 1.16) 0.54 (0.34 to 0.85) 0.55 (0.37 to 0.80) 51–75 1.6 (0.85 to 3.05) 0.54 (0.27 to 1.09) 0.74 (0.46 to 1.21) 76–100 1.04 (0.51 to 2.10) 1.32 (0.83 to 2.10) 1.25 (0.83 to 1.88) >100 1.16 (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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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