Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Kidney Int. 2018 Jan;93(1):188-194. doi: 10.1016/j.kint.2017.06.014. Epub 2017 Aug 23.
Home hemodialysis (HHD) has many benefits, but less is known about relative outcomes when comparing different home-based hemodialysis modalities. Here, we compare patient and treatment survival for patients receiving short daily HHD (2-3 hours/5 plus sessions per week), nocturnal HHD (6-8 hours/5 plus sessions per week) and conventional HHD (3-6 hours/2-4 sessions per week). A nationally representative cohort of Canadian HHD patients from 1996-2012 was studied. The primary outcome was death or treatment failure (defined as a permanent return to in-center hemodialysis or peritoneal dialysis) using an intention to treat analysis and death-censored treatment failure as a secondary outcome. The cohort consisted of 600, 508 and 202 patients receiving conventional, nocturnal, and short daily HHD, respectively. Conventional-HHD patients were more likely to use dialysis catheter access (43%) versus nocturnal or short daily HHD (32% and 31%, respectively). Although point estimates were in favor of both therapies, after multivariable adjustment for patient and center factors, there was no statistically significant reduction in the relative hazard for the death/treatment failure composite comparing nocturnal to conventional HHD (hazard ratio 0.83 [95% confidence interval 0.66-1.03]) or short daily to conventional HHD (0.84, 0.63-1.12). Among those with information on vascular access, patients receiving nocturnal HHD had a relative improvement in death-censored treatment survival (0.75, 0.57-0.98). Thus, in this national cohort of HHD patients, those receiving short daily and nocturnal HHD had similar patient/treatment survival compared with patients receiving conventional HHD.
家庭血液透析（HHD）有许多好处，但在比较不同家庭血液透析方式的相对结果方面知之甚少。在这里，我们比较了接受短时间每日 HHD（2-3 小时/每周 5 次以上）、夜间 HHD（6-8 小时/每周 5 次以上）和常规 HHD（3-6 小时/每周 2-4 次）的患者的患者和治疗存活率。研究了来自 1996 年至 2012 年的加拿大 HHD 患者的全国代表性队列。主要结局是使用意向治疗分析的死亡或治疗失败（定义为永久性返回中心血液透析或腹膜透析），并将死亡校正的治疗失败作为次要结局。该队列包括分别接受常规、夜间和短时间每日 HHD 的 600、508 和 202 名患者。与夜间或短时间每日 HHD 相比，常规 HHD 患者更可能使用透析导管（43%对 32%和 31%）。尽管点估计对两种疗法都有利，但在对患者和中心因素进行多变量调整后，夜间 HHD 与常规 HHD 相比，死亡/治疗失败复合终点的相对风险无统计学显著降低（危险比 0.83 [95%置信区间 0.66-1.03]）或短时间每日 HHD 与常规 HHD（0.84，0.63-1.12）。在有血管通路信息的患者中，接受夜间 HHD 的患者死亡校正治疗存活率相对改善（0.75，0.57-0.98）。因此，在这个 HHD 患者的全国队列中，与接受常规 HHD 的患者相比，接受短时间每日和夜间 HHD 的患者具有相似的患者/治疗存活率。
