Mailloux L U, Kapikian N, Napolitano B, Mossey R T, Bellucci A G, Wilkes B M, Vernace M A, Miller I J
Department of Medicine, North Shore University Hospital, Manhasset, NY 11030, USA.
Adv Ren Replace Ther. 1996 Apr;3(2):112-9. doi: 10.1016/s1073-4449(96)80050-1.
In the United States, from 1983 to 1993, home hemodialysis use has decreased from 6% to 1.3% of the dialysis population, whereas continuous ambulatory peritoneal dialysis (CAPD) has increased to 20%. Most home hemodialysis programs have withered away because of current patient mix, increase in CAPD, proliferation of outpatient centers, disinterest in nephrologists, and fear of self-cannulation by patients. From 1970 through 1993, 896 patients began dialysis at North Shore and were followed up through 1994. During this period, 687 patients were on in-center hemodialysis, 95 on CAPD, 74 on home hemodialysis, and 40 on in-center peritoneal dialysis. The home hemodialysis patients were younger, with a median age of 44 versus 59 years for in-center hemodialysis patients, and had less comorbidity. The home hemodialysis group had fewer diabetic patients and no renal vascular patients. The 5-year and median survival estimates were significantly better for the home hemodialysis patients versus other dialysis modalities. More home hemodialysis patients received transplants. Compared with the other dialysis modalities, home hemodialysis patients showed significantly improved survival rates. When matched by age, sex, and end-stage renal disease (ESRD) diagnosis to corresponding in-center hemodialysis, the home hemodialysis patients still had significantly better survival rates, but the home hemodialysis patients had less comorbidity. In conclusion, home hemodialysis patients survive longer and have better rehabilitation than other dialysis patients. Reasons for better survival in addition to a younger age and more favorable ESRD diagnosis may include less comorbidity, more patient involvement, and longer dialysis time. Because of these better outcomes, home hemodialysis should be offered to more ESRD patients.
在美国，从1983年到1993年，家庭血液透析在透析人群中的使用率从6%降至1.3%，而持续性非卧床腹膜透析（CAPD）的使用率则升至20%。由于当前患者构成、CAPD的增加、门诊中心的增多、肾病学家的不感兴趣以及患者对自我插管的恐惧，大多数家庭血液透析项目已逐渐消失。从1970年到1993年，896名患者在北岸开始透析，并一直随访至1994年。在此期间，687名患者接受中心血液透析，95名接受CAPD，74名接受家庭血液透析，40名接受中心腹膜透析。家庭血液透析患者较为年轻，中位年龄为44岁，而中心血液透析患者为59岁，且合并症较少。家庭血液透析组的糖尿病患者较少，没有肾血管疾病患者。家庭血液透析患者的5年生存率和中位生存估计值明显优于其他透析方式。接受移植的家庭血液透析患者更多。与其他透析方式相比，家庭血液透析患者的生存率有显著提高。当按年龄、性别和终末期肾病（ESRD）诊断与相应的中心血液透析患者匹配时，家庭血液透析患者的生存率仍然明显更高，但合并症较少。总之，家庭血液透析患者比其他透析患者存活时间更长，康复情况更好。除了年龄较小和ESRD诊断更有利外，生存情况更好的原因可能包括合并症较少、患者参与度更高以及透析时间更长。由于这些更好的结果，应该为更多的ESRD患者提供家庭血液透析。
