How do hospitalization patterns of home hemodialysis patients compare with a reasonably well dialysis patient cohort?

BACKGROUND The home hemodialysis (HHD) treatment option has been associated with improved patient outcomes compared to in-center hemodialysis (ICHD) programs. What is not quite clear is the influence of patient selection bias on the perceived benefits of HHD. The purpose of this study was to explore the potential benefits of HHD by comparing the admission patterns of HHD patients with a control group from a reasonably well dialysis patient cohort, which in this case were satellite hemodialysis patients on a Category 1 transplant waiting list (Cat1 SHD). METHODS A single center retrospective randomized cohort study of HHD and Cat1 SHD patients who were on these two treatment modalities from August 2012 to August 2013 was performed to obtain a sample of 25 patients for each group. RESULTS The mean length of stay in hospital was 5.9 days for HHD patients and 6.7 days for Cat1 SHD group (P=0.8). Eighteen admissions were observed for both groups (0.72 admissions/patient-year; P=0.5). HHD patients spent 71 days and Cat1 SHD patients spent 85 days in hospital (2.8 and 3.4 days/patient-year respectively; P<0.005). The mean serum potassium level for HHD patients was 4.1 (3.1-6.5) mEq/L versus 5.0 (3.7-6.1) mEq/L for Cat1 SHD patients (P=0.001) and the mean phosphate level was 1.1 (0.56-2.38) mg/dL and 1.5 (0.43-3.2) mg/dL (P=0.02) for the respective groups. CONCLUSION This study confirms the superiority of the HHD treatment option in improving patient outcomes. Admission patterns of HHD patients fared very well against a control group which consisted of reasonably well dialysis patients.