Home hemodialysis (HHD) treatment failure is associated with increased mortality, a new study finds.

Of 19,306 patients receiving hemodialysis in the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry from 2005 to 2015, a total of 2457 started on or transitioned to HHD and 577 returned to in-center hemodialysis (ICHD) at some point.

In both univariate and multivariate analysis, HHD treatment failure (defined as transition from HHD to in-center hemodialysis) was significantly associated with 3.9, 3.3-, and 2.3-fold increased risks for all-cause mortality in the first 30 days, 30-90 days, and 90 days or more, respectively, compared with continued HHD, David J. Semple, PhD, of Auckland District Health Board in Auckland, New Zealand, and colleagues reported in the American Journal of Kidney Diseases. When ICHD was the first modality, treatment failure was significantly associated with a 1.9-fold increased mortality risk compared with continued HHD. HHD return (after a period of ICHD and HHD) was associated with 1.1-fold increased mortality risk compared with continued HHD.

A competing risk analysis showed that withdrawal from dialysis was a significant cause of early mortality within 90 days after return to ICHD from HHD. Both withdrawal from dialysis and cardiovascular death significantly accounted for late mortality.


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Other significant independent predictors of death included older age, late dialysis referral, smoking, non-glomerular cause of kidney failure, and major comorbidities, including coronary artery disease, cerebrovascular disease, peripheral vascular disease, chronic lung disease, and diabetes.

The causes of HHD treatment failure were not available for this study, precluding further meaningful analysis, according to the investigators.

According to Dr Semple’s team, “the need to transition from HHD to ICHD should now prompt an examination of the patient’s overall health trajectory and, where appropriate, increased support and consideration of advanced care planning.”

Patients who resume HHD after a period of ICHD may have technical, vascular access, or social issues, rather than clinically significant changes in health status and frailty, the investigators suggested.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Semple DJ, Sypek M, Ullah S, Davies C, McDonald S. Mortality after home hemodialysis treatment failure and return to in-center hemodialysis. Am J Kidney Dis. Published online July 15, 2021. doi:10.1053/j.ajkd.2021.05.021

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