Nishio-Lucar Angie G, Bose Subhasish, Lyons Genevieve, Awuah Kwabena T, Ma Jennie Z, Lockridge Robert S
Division of Nephrology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.
Lynchburg Nephrology Physicians, PLLC, Lynchburg, Virginia, USA.
Kidney Int Rep. 2020 Jan 9;5(3):296-306. doi: 10.1016/j.ekir.2019.12.019. eCollection 2020 Mar.
Kidney transplantation (KT) remains the treatment of choice for end-stage kidney disease (ESKD), but access to transplantation is limited by a disparity between supply and demand for suitable organs. This organ shortfall has resulted in the use of a wider range of donor kidneys and, in parallel, a reexamination of potential alternative renal replacement therapies. Previous studies comparing Canadian intensive home hemodialysis (IHHD) with deceased donor (DD) KT in the United States reported similar survival, suggesting IHHD might be a plausible alternative.
Using data from the Scientific Registry of Transplant Recipients and an experienced US-based IHHD program in Lynchburg, VA, we retrospectively compared mortality outcomes of a cohort of IHHD patients with transplant recipients within the same geographic region between October 1997 and June 2014.
We identified 3073 transplant recipients and 116 IHHD patients. Living donor KT ( = 1212) had the highest survival and 47% reduction in risk of death compared with IHHD (hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.34-0.83). Survival of IHHD patients did not statistically differ from that of DD transplant recipients ( = 1834) in adjusted analyses (HR: 0.96; 95% CI: 0.62-1.48) or when exclusively compared with marginal (Kidney Donor Profile Index >85%) transplant recipients (HR: 1.35; 95% CI: 0.84-2.16).
Our study showed comparable overall survival between IHHD and DD KT. For appropriate patients, IHHD could serve as bridging therapy to transplant and a tenable long-term renal replacement therapy.
肾移植（KT）仍然是终末期肾病（ESKD）的首选治疗方法，但合适器官的供需差距限制了移植的可及性。这种器官短缺导致了更广泛地使用供体肾脏，同时也促使人们重新审视潜在的替代性肾脏替代疗法。先前在美国比较加拿大强化家庭血液透析（IHHD）与 deceased donor（DD）KT的研究报告了相似的生存率，这表明 IHHD 可能是一种可行的替代方法。
利用移植受者科学登记处的数据以及弗吉尼亚州林奇堡一个经验丰富的美国 IHHD 项目，我们回顾性比较了 1997 年 10 月至 2014 年 6 月同一地理区域内一组 IHHD 患者与移植受者的死亡率结果。
我们确定了 3073 名移植受者和 116 名 IHHD 患者。活体供体 KT（n = 1212）的生存率最高，与 IHHD 相比死亡风险降低了 47%（风险比[HR]：0.53；95%置信区间[CI]：0.34 - 0.83）。在调整分析中，IHHD 患者的生存率与 DD 移植受者（n = 1834）的生存率没有统计学差异（HR：0.96；95%CI：0.62 - 1.48），或者仅与边缘性（肾脏供体特征指数>85%）移植受者相比时也无差异（HR：1.35；95%CI：0.84 - 2.16）。
我们的研究表明 IHHD 和 DD KT 的总体生存率相当。对于合适的患者，IHHD 可作为移植的过渡治疗和一种可行的长期肾脏替代疗法。
