Home hemodialysis treatment and outcomes: Retrospective analysis of the Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) cohort 11 Medical and Health Sciences 1103 Clinical Sciences

Shashidhar Cherukuri, Maria Bajo, Giacomo Colussi, Roberto Corciulo, Hafedh Fessi, Maxence Ficheux, Maria Slon, Eric Weinhandl, Natalie Borman

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: Utilization of home hemodialysis (HHD) is low in Europe. The Knowledge to Improve Home Dialysis Network in Europe (KIHDNEy) is a multi-center study of HHD patients who have used a transportable hemodialysis machine that employs a low volume of lactate-buffered, ultrapure dialysate per session. In this retrospective cohort analysis, we describe patient factors, HHD prescription factors, and biochemistry and medication use during the first 6 months of HHD and rates of clinical outcomes thereafter. Methods: Using a standardized digital form, we recorded data from 7 centers in 4 Western European countries. We retained patients who completed ≥6 months of HHD. We summarized patient and HHD prescription factors with descriptive statistics and used mixed modeling to assess trends in biochemistry and medication use. We also estimated long-term rates of kidney transplant and death. Results: We identified 129 HHD patients; 104 (81%) were followed for ≥6 months. Mean age was 49 years and 66% were male. Over 70% of patients were prescribed 6 sessions per week, and the mean treatment duration was 15.0 h per week. Median HHD training duration was 2.5 weeks. Mean standard Kt/V urea was nearly 2.7 at months 3 and 6. Pre-dialysis biochemistry was generally stable. Between baseline and month 6, mean serum bicarbonate increased from 23.1 to 24.1 mmol/L (P = 0.01), mean serum albumin increased from 36.8 to 37.8 g/L (P = 0.03), mean serum C-reactive protein increased from 7.3 to 12.4 mg/L (P = 0.05), and mean serum potassium decreased from 4.80 to 4.59 mmol/L (P = 0.01). Regarding medication use, the mean number of antihypertensive medications fell from 1.46 agents per day at HHD initiation to 1.01 agents per day at 6 months (P < 0.001), but phosphate binder use and erythropoiesis-stimulating agent dose were stable. Long-term rates of kidney transplant and death were 15.3 and 5.4 events per 100 patient-years, respectively. Conclusions: Intensive HHD with low-flow dialysate delivers adequate urea clearance and good biochemical outcomes in Western European patients. Intensive HHD coincided with a large decrease in antihypertensive medication use. With relatively rapid training, HHD should be considered in more patients.

Original languageEnglish (US)
Article number262
JournalBMC Nephrology
Volume19
Issue number1
DOIs
StatePublished - Oct 11 2018

Keywords

  • Adequacy
  • Antihypertensive medication
  • Home hemodialysis
  • Intensive hemodialysis
  • Kidney transplant
  • Lactate
  • Low-flow dialysate
  • Ultrapure dialysate

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study

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