#2750 Daily home hemodialysis is associated with a lower mortality rate compared with in-center hemodialysis in French patients

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Abstract Background and Aims Home hemodialysis (HD) offers several advantages over conventional 3-times-weekly in-center HD, with better preservation of health-related quality of life and treatment flexibility, but its effect on mortality is poorly understood. We therefore aimed to compare daily home hemodialysis with in-center hemodialysis in France for the risk of death in incident patients (to minimize the risk of bias). Method Design: National, population-based, cohort study with propensity score matching (PSM) to mitigate selection bias on patient profiles. Setting Individual healthcare data from the French National Health Data System for patients with end-stage kidney disease undergoing dialysis cross-referenced with the French National Cost Scale of the health ministry. Participants A total of 72 358 patients receiving HD were identified and their data collected for the 24-month inclusion period, from January 2016 to December 2017. After exclusion of patients treated < 90 days, and those without a treatment schedule or incomplete data for a social disadvantage score, 42 605 patients were selected (28 317 prevalent and 14 288 incident HD patients). After PSM, 265 incident patients (in-center HD, n = 212; daily home HD, n = 53) were analyzed for mortality after two years of a follow-up. Main outcome and measure Crude mortality in incident patients after PSM and the potential factors influencing death in daily home HD and in-center HD. Results The gross death rate after 2 years of follow-up in incident patients treated with in-center HD was 10.4% vs. 1.9% in patients treated with daily home HD (P = 0.049, Chi2 test; relative risk (RR)=5.5 [95% CI, 1.003 to 31.97]. Survival analysis using the Kaplan–Meier curve showed no censoring case and a significant difference in the cumulative risk of death between incident patients receiving in-center HD and patients receiving daily home HD (W = 5140, P = 0.03, Wilcoxon–Mann–Whitney test). Multivariate analysis using the Cox proportional hazards model showed that the hazard ratio (HR) for death was increased 7-fold by in-center HD compared with daily home HD. Similarly, diabetes mellitus and disability strongly increased the HR for death (approximately 3-fold) in incident patients in the multivariate analysis. Conclusion Daily home hemodialysis improves outcomes for French incident dialysis patients and significantly prolongs life expectancy compared to in-center hemodialysis.

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