NDT Advance Access published online on July 7, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp295
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Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients
1 Division of Nephrology, Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB 2 Division of Nephrology, Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, BC 3 Division of Nephrology, Department of Medicine, Toronto General Hospital, University of Toronto 4 Toronto Region Dialysis Registry, University Health Network 5 Department of Nephrology, Humber River Regional Hospital, University of Toronto, Toronto, ON, Canada
Correspondence and offprint requests to: Robert P. Pauly; E-mail: robert.pauly{at}ualberta.ca
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Abstract |
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Background. Kidney transplantation is the gold standard renal replacement therapy. Nocturnal haemodialysis (NHD) is an intensive dialysis modality (6–8 h/session, 3–7 sessions/week) associated with a significant improvement of clinical and biochemical parameters compared to conventional dialysis. To date, no studies have compared survival in patients treated with NHD and kidney transplantation.
Methods. Using data from two regional NHD programmes and the USRDS from 1994 to 2006, we performed a matched cohort study comparing survival between NHD and deceased and living donor kidney transplantation (DTX and LTX) by randomly matching NHD patients to transplant recipients in a 1:3:3 ratio. The independent association of treatment modality with survival was determined using Cox multivariate regression.
Results. The total study population consisted of 177 NHD patients matched to 1062 DTX and LTX recipients (total 1239 patients) followed for a maximum of 12.4 years. During the follow-up period, the proportion of deaths among NHD, DTX and LTX patients was 14.7%, 14.3% and 8.5%, respectively (P = 0.006). We found no difference in the adjusted survival between NHD and DTX (HR 0.87, 95% CI 0.50–1.51; NHD reference group), while LTX survival was better (HR 0.51, 95% CI 0.28–0.91).
Conclusions. These results indicate that NHD and DTX survival is comparable, and suggest that this intensive dialysis modality may be a bridge to transplantation or even a suitable alternative in the absence of LTX in the current era of growing transplant waiting lists and organ shortage.
Keywords: kidney transplantation; mortality; nocturnal haemodialysis; survival analysis
Received for publication: 27. 3.09
Accepted in revised form: 26. 5.09