Home hemodialysis as good as transplant

Home dialysis treatment for kidney failure is as good for survival for a patient as receiving an organ transplant from a deceased donor, a new study suggests.

TORONTO — Home dialysis treatment for kidney failure is as good for survival for a patient as receiving an organ transplant from a deceased donor, a new study suggests.

In the study conducted by Canadian researchers, a total of more than 1,200 patients were followed for up to 12 years.

The subjects came from three populations — those who received kidney transplants from either a deceased or living donor, and those receiving night home hemodialysis.

Night home hemodialysis is an intensive form of frequent and prolonged treatment done while the patient sleeps which lasts for six-to-eight hours a night for up to seven nights a week, compared to the 12 hours of conventional dialysis typically done at a hospital or health-care facility.

Documented benefits of night home hemodialysis include improvement of blood pressure control and heart function, said Dr. Christopher Chan, one of the study’s principal investigators.

Dialysis patients were from Toronto General Hospital and Humber River Regional Hospital, while information on transplant patients came from the United States Renal Data System database.

The three groups were matched to compare survival of those receiving dialysis and those who were recipients of kidneys from deceased and living donors.

According to findings published in the international September issue of Nephrology Dialysis Transplantation, researchers found survival for night home hemodialysis patients was comparable to that of patients who had received kidney transplants from deceased donors.

Survival among patients who received kidneys from living donors was better than both groups.

Since people on a donor transplant list will wait longer than those able to have a pre-emptive transplant, researchers wanted to ensure the comparisons between groups would be valid, Chan said.

To that end, they matched the duration of wait time to the amount of time the patient had spent on standard dialysis before they converted to nightly hemodialysis.

Chan, medical director of home hemodialysis at Toronto General Hospital, said the study marks the first time they’ve be able to document the long-term survival of patients using this type of dialysis.

What’s more, the therapy provides a “suitable alternative” for patients who may not be able to have a transplant, which can occur when there are too many complications or an immunological risk.

“I think our study will provide another option for patients who are looking towards improving their survival and also improving their outcomes,” said Chan, who is also an associate professor of medicine at the University of Toronto.

Because of the technical complexity and some other barriers towards adopting home dialysis, Chan said the therapy may not be optimal for all who require the treatment.

There may be some who view it as too complicated.

Chan said with technical changes and innovation, access can be improved for patients wanting to try it.

“I think we need to allow ourselves to see through these barriers and also hopefully with the help of funding agencies and also with dialysis manufacturers actually start changing the paradigm of developing more user-friendly machines, more incentives towards adopting home dialysis, and perhaps we might see change in what is currently thought of as standard therapy.”

Dr. Michael Copland, a nephrologist at Vancouver General Hospital and provincial medical director for independent hemodialysis, said he is “quite excited” by the findings.

“This is one of the first studies that shows a similarity in terms of the survival of patients doing nocturnal dialysis and patients receiving a deceased donor transplant, which is exciting.”

Copland said nocturnal dialysis comprises between about five to seven per cent of B.C.’s total dialysis population.

The next step has to be looking towards how the information can be used to encourage people to consider night dialysis, or to see if there are other ways to increase dosage.

That’s not to say that conventional hemodialysis isn’t a good thing, he added.

“It’s still a conventional life-supporting therapy that’s keeping people alive,” he said.

“But really what we’re talking about with this sort of a study is ‘What can we do to improve the quality of life and hopefully the quantity of life as well for people?’ and that I think is what really the push behind this study would be trying to show.”

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