Patients with failing kidneys who need to undergo dialysis will do equally well if they perform dialysis at home or if they go to a dialysis center, according to the largest study to date comparing the two approaches.
Based on the findings, patients who require dialysis to clean their blood should choose a method based on their own lifestyle and preferences, Dr. Rajnish Mehrotra of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, told Reuters Health.
Just 7 percent of dialysis patients currently opt for the home treatment, Mehrotra and his colleagues point out in the Archives of Internal Medicine. Given the similarity in outcomes-and the fact that annual per-patient costs for home dialysis are about $20,000 lower than for standard dialysis-the Center for Medicare & Medicaid Services has made changes in reimbursement to promote more widespread use of the less expensive approach, they add.
In home dialysis, technically known as peritoneal dialysis, fluid is introduced into the patient's abdominal cavity through a permanent catheter, and periodically flushed out and replaced with fresh fluid. Patients are typically hooked up to a machine that performs this process automatically as they sleep at night. They may also need to perform the procedure manually once a day, according to Mehrotra.
Hemodialysis, in which a patient's blood is run through a machine that removes waste products and excess water, usually requires three visits a week to a dialysis center.
To compare outcomes for both types of dialysis using the most recent information available, Mehrotra and his colleagues looked at data on 620,020 patients on hemodialysis, and 64,406 on home dialysis from 1996 to 2004, following patients for up to five years.
Among patients treated during the most recent period they studied (2002-2004), the researchers found no difference in survival between home dialysis and hemodialysis users.
Advantages of home dialysis include greater autonomy and control for the patient, and also more freedom to work, go to school, or even travel, Mehrotra noted. However, some patients prefer hemodialysis because they would rather not have the responsibility; others may not want daily reminders of their illness, he added.
At-home hemodialysis is another increasingly popular option, he noted, although it is more complicated than peritoneal dialysis.
Approximately 370,000 Americans have severe kidney disease requiring dialysis, with 100,000 new cases added each year. Life expectancy for dialysis patients without a kidney transplant is less than four years.
According to Mehrotra, the health care system has not been doing enough to inform patients about the option of home dialysis, and physicians aren't receiving adequate training in this type of dialysis.
His current study was funded by the National Institutes of Health and Baxter Health Care, a maker of supplies for both home- and clinic-based dialysis methods.
A survey published in the same issue of the journal supports the possibility that doctors are not as well informed about dialysis options as they should be. Dr. Nancy G. Kutner of Emory University in Atlanta and her colleagues found that of 1,621 patients starting dialysis, just 61 percent said their doctor had discussed home dialysis with them, and just 11 percent of those who had been informed of the home option chose that type of dialysis.
In an accompanying editorial, Dr. Kirsten L. Johansen points out that Mehrotra and his colleagues found in an earlier study that only a third of dialysis patients in southern California had been told about home dialysis, while other research has found that half of patients presented with this option chose it.
It seems that nephrologists are discussing PD as an option with more of their patients, but they may not be doing a very good job at it, Johansen writes.