Department of Clinical Sciences Lund, Nephrology, Lund University, Skane University Hospital, Njurmedicin exp A5:04, 171 76, Stockholm, Sweden.
Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden.
BMC Nephrol. 2019 Dec 30;20(1):480. doi: 10.1186/s12882-019-1644-z.
Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population.
The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD.
RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower annual admission rate and number of days in hospital. (median 1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD.
Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.
与机构血液透析（IHD）和腹膜透析（PD）相比，居家血液透析（HHD）患者的生存率更高。比较 HHD 与 IHD 或 PD 之间发病率的报告很少，在欧洲人群中则没有。本研究旨在比较瑞典人群中不同治疗方式的发病率。
使用瑞典肾脏登记处检索开始接受 HHD、IHD 或 PD 治疗的患者。根据性别、年龄、合并症和开始日期对患者进行匹配。使用瑞典住院患者登记处确定开始肾脏替代治疗（RRT）前的合并症和 RRT 期间的住院情况。比较 HHD 和 PD 之间的透析技术生存率。
有 152 名患者开始接受 HHD 治疗；这些患者与 608 名 IHD 患者和 456 名 PD 患者相匹配。与 IHD（2.2；14）和 PD（2.8；20）相比，HHD 患者的年住院率和住院天数明显较低（中位数分别为 1.7 次住院；12 天）。与 IHD 相比，HHD 患者的心血管疾病诊断年住院率较低；与 PD 相比，HHD 患者的传染病诊断年住院率较低。与 PD 相比，HHD 患者的透析技术生存率明显更长。
选择 HHD 作为初始 RRT 的患者与接受 IHD 和 PD 治疗的患者相比，在医院的住院时间更短，并且比 PD 患者更有可能继续使用初始治疗方式。这些优势，加上更好的生存率和更高的肾移植可能性，是促进 HHD 使用的重要激励因素。
