PracticeUpdate Conference Series ISN WCN 2019

Australian Study Demonstrates Benefits of Home Dialysis Findings suggest access to home dialysis should be improved. D emonstrated benefits of home dialysis for patients with end-stage kidney failure (ESKD) suggest that

calcium, phosphate and parathyroid hormone), proportion of patients in each group with a hemoglobin below 100 g/L and phosphate above 1.8mmol/L, and whether transplanted patients were alive 6 months after their transplant. In all, there were 542 patients included in the analysis, with a cumulative 2135 per- son-years of data. The incidence rate of death was 6 per 100 person-years. There were no significant differences between groups in average age, gender, race, smoking status, late referral, or cause of ESKD. Body mass index (BMI) was signif- icantly higher in home dialysis patients: 30.2 kg/m 2 compared with 27.3 kg/m 2 (P < .0001). There was also a significantly higher prevalence of cerebrovascular disease at baseline in the satellite group, as compared with home dialysis patients (P = .001), but no differences were found in the prevalence of lung disease, coro- nary artery disease, peripheral vascular disease, cancer, diabetes or hepatitis C. Home dialysis patients had a significantly reduced risk of death (hazard ratio 0.28; 95% CI 0.17–0.47; P < .001). Transplant rates were also higher in home dialysis patients (61.8%) compared with satellite dialysis patients (51.6%, P = .03). The sur- vival rate at 6 months post-transplantation was very high in both groups, 99.5% in satellite dialysis patients and 100% in home dialysis patients. The proportion of patients with low hemo- globin, which was defined as <100 g/L, was not significantly different between groups (P = .35). High phosphate levels, defined as >1.80 mmol/L, were found in 46.6% of in satellite dialysis patients compared with 35.8% of home patients (P < .05). The study authors conclude in their abstract that home dialysis, “is associated with reduced risk of mortality, increased rates of transplantation, and improved phosphate control in an Australian dialy- sis population. With only 9.6% of dialysis patients in Australia dialysing at home, it would be worthwhile working to improve access to home [dialysis] for Australians with ESKD.”

The need for travel is removed with home dialysis, and the number of hours on dialysis increases from 5 to 8 hours on alternate days. Because most home dialysis patients do the procedure overnight, this results in less interference with their other daily activities of living. The intent of the current study was to assess whether there were significant dif- ferences in outcomes between home and satellite dialysis patients in an Australian centre. Emily Yeung, MBBS, of the Monash Medical Centre in Clayton, Victoria, pre- sented the findings. Home dialysis patients from a tertiary care centre were included in the study start- ing in 2008, and incident patients were added up until June 2017. Three satellite dialysis patients served as controls and were matched to each home dialysis patient on three criteria: age, gender, and cause of ESKD. The primary outcomes were all-cause mortality (censored for transplantation) and transplantation. Secondary outcomes were average bio- chemical levels (hemoglobin, corrected

increasing access to this service is worth- while, according to research presented at WCN 2019. Earlier research has shown that home dialysis has been associated with improve- ments in both clinical and non-clinical outcomes. Improvements in biochemical parameters and intradialytic blood pres- sure control have been reported along with a reduction in recovery time after dialysis, fewer adverse events (including hospitalization), and an overall improved quality of life and survival. At the end of 2017 in Australia, there was a total of 1023 patients on home dialy- sis, slightly less than 10% of all dialysis patients in the country. Satellite dialysis, on the other hand, accounts for 51.4% of all hemodialysis patients in Australia. This procedure requires that patients travel to a medical centre, usually 3 times a week for a period of 4 to 5 hours of dialysis per session.

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PRACTICEUPDATE CONFERENCE SERIES • WCN 2019