Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Am J Kidney Dis. 2013 Apr;61(4):598-607. doi: 10.1053/j.ajkd.2012.10.020. Epub 2012 Dec 7.
There is revived interest in home hemodialysis (HD), which is spurred by cost containment and experience indicating lower mortality risk compared with facility HD and peritoneal dialysis (PD). Social barriers to home HD include disruptions to the home environment, interference with family life, overburdening of support networks, and fear of social isolation. A submodality of home HD, in which patients from urban settings undertake independent HD in unstaffed nonmedical community-based home-like settings, is described in this study. The survival of patients treated in this manner is compared with that of those using conventional home HD.
An observational cohort study using the Australia and New Zealand Dialysis and Transplant Registry.
SETTING & PARTICIPANTS: All adult patients starting renal replacement therapy in New Zealand since March 31, 2000, followed up through December 31, 2010.
The main predictor was time-varying dialysis modality (home HD, facility HD, PD, and community house HD), adjusting for the confounding effects of patient demographics and time-varying comorbid conditions.
Patient mortality.
4,709 patients with 12,883 patient-years of follow-up (5,591, PD; 1,532, home HD; 5,647, facility HD; and 113, community house HD) were analyzed. Community house HD patients were younger, healthier, and more likely to be Pacific people than those using other modalities, including home HD. Relative to home HD, adjusted mortality HRs were 2.18 (95% CI, 1.78-2.67) for facility HD, 2.17 (95% CI, 1.77-2.66) for PD, and 1.48 (95% CI, 0.64-3.40) for community house HD.
Small number of patients receiving community house HD, possible residual confounding from the limited collection of comorbid conditions (eg, no collection of cognitive or motor impairment), and absence of socioeconomic, medication, and biochemical data in analyses.
Within limits, this study shows community house HD to be both safe and effective. Community house HD provides an option to improve the uptake of home HD.
家庭血液透析（HD）重新受到关注，这是出于成本控制的考虑，并且有经验表明，与设施 HD 和腹膜透析（PD）相比，家庭 HD 的死亡率风险更低。家庭 HD 的社会障碍包括对家庭环境的破坏、干扰家庭生活、使支持网络负担过重以及对社会孤立的恐惧。本研究介绍了家庭 HD 的一种亚模式，即城市环境中的患者在非医疗社区式家庭环境中进行独立的 HD。比较了以这种方式治疗的患者的生存率与常规家庭 HD 的生存率。
使用澳大利亚和新西兰透析和移植登记处的观察性队列研究。
所有自 2000 年 3 月 31 日起在新西兰开始肾脏替代治疗的成年患者，随访至 2010 年 12 月 31 日。
主要预测因素是随时间变化的透析方式（家庭 HD、设施 HD、PD 和社区住房 HD），同时调整了患者人口统计学和随时间变化的合并症的混杂影响。
对 4709 名患者进行了 12883 患者年的随访（5591 名 PD；1532 名家庭 HD；5647 名设施 HD；113 名社区住房 HD）。与其他模式（包括家庭 HD）相比，社区住房 HD 患者更年轻、更健康，并且更有可能是太平洋人。与家庭 HD 相比，调整后的死亡率 HR 分别为设施 HD 2.18（95%CI，1.78-2.67）、PD 2.17（95%CI，1.77-2.66）和社区住房 HD 1.48（95%CI，0.64-3.40）。
接受社区住房 HD 的患者人数较少，由于合并症的收集有限（例如，未收集认知或运动障碍）可能存在残余混杂，以及分析中缺乏社会经济、药物和生化数据。
在一定范围内，本研究表明社区住房 HD 既安全又有效。社区住房 HD 为提高家庭 HD 的普及率提供了一种选择。
