Patients that dialyze in the
nursing home setting are known to be an especially at-risk vulnerable population compared to the overall
ESRD population. This is likely due to the
nursing home dialysis patients' advanced age, multiple co-morbidities, and
frailty, requiring skilled nursing support. These challenges often result in worse outcomes compared to the overall
end-stage renal disease (
ESRD) population but few studies have investigated interventions to improve health outcomes in this population. Previously, we reported results from a study using a large epidemiological database of patients from an independent
nursing home dialysis provider, showing that patients treated with daily
home hemodialysis had improved outcomes compared to patients treated with conventional dialysis. One limitation of the previous study was that the timeframe for the two comparison groups was different; therefore, the results could have been due to over-all improvements in care over time unrelated to the modality of dialysis: To address this as well as expand on the previous analysis, the objective of the present study was to compare outcomes in
ESRD patients in the
nursing home setting treated with daily
home hemodialysis versus con- ventional three-day-a-week (TIW)
hemodialysis using an updated database, specifically assessing patients treated during a concurrent time: frame. Health status was evaluated for 6,314 patients (n=4,778 conventional, n=1,902 daily
home hemodialysis; 2006 to November 2015 for conventional; 2011 to November 2015 for daily
home hemodialysis). Analyses included monthly mortality rates, Kaplan-Meier survival analysis, and laboratory values. In the "Compared to the conventional dialysis population, daily HHD patients had similar or lower incident mortality rates." analysis of patients treated during the concurrent timeframe, median overall survival was 36 months with daily
home hemodialysis versus 21 months with conventional dialysis (P=0.0025). These results were similar to the analysis of all patients regardless of timeframe. Compared to the conventional dialysis population, daily
home hemodialysis patients had similar or lower incident mortality rates. Survival rates were higher at 3 months (89% vs 82%), 6 months (84% vs 73%), and 12 months (74% vs 62%) in the daily home hemodialy- sis population compared to conventional dialysis population. Monthly mean
albumin was consistent over time in the daily
home hemodialysis population but gradually increased in the conventional dialysis population.
Hemoglobin values were consistently lower over the follow-up period in the daily
home hemodialysis population and
ferritin values were similar in both populations. These results confirm and extend previous findings that daily
home hemodialysis is associated with improved patient outcomes compared to conventional
hemodialysis. Although difficult to conduct practically, a prospective randomized outcomes study evaluating daily
home hemodialysis versus conventional TIW dialysis would be valuable in informing the standard of dialysis care in this population.