J GAUTIER1, L HIGNELL3, H JONES1, E WEINHANDL2
1NxStage Medical Inc, Lawrence, United States, 2University of Minnesota, College of Pharmacy, Minneapolis, United States, 3NxStage Medical UK Ltd, Amersham, United Kingdom
Purpose: In Australia, 13% of haemodialysis patients dialyze at home, almost always with traditional equipment. Kidney Health Australia recommends “home dialysis first” but utilization of home haemodialysis (HHD) is not increasing. We evaluated outcomes on HHD with a flexible device that is designed for patient use and employs low dialysate volume (LDV).
Methods: We collected data from HHD patients at 9 centers in western Europe. We recorded haemodialysis prescription, biochemical, and medication data at HHD initiation, and at 6 and 12 months thereafter.
Results: The cohort comprised 182 patients. Ranges of age, body mass index, and Charlson score were 15-84 years, 13.3-50.8 kg/m2, and 2-11 points, respectively. Mean training duration was 18.9 sessions. Most (93.4%) patients were prescribed 5 or 6 sessions/week, and session duration was commonly 2.0-3.5 hours; mean dialysate volume was 23.9 L/session. Mean ultrafiltration (UFR) rate declined from 6.9 to 6.6 mL/hour/kg between HHD initiation and 12 months, with a halving of patients with UFR ≥10 mL/hour/kg. Mean standardized Kt/V was 2.6 at all times; the majority of patients had standardized Kt/V between 2.4 and 3.0 at 12 months. Serum concentrations of bicarbonate, potassium, calcium, phosphorus, albumin, and hemoglobin were stable. The percentage of patients using no antihypertensive medications steadily increased from 27% at HHD initiation to 36% at 6 months and 42% at 12 months. After 36 months, 39% of patients remained on HHD, 31% had received a kidney transplant, and only 10% had died.
Conclusions: HHD with LDV is viable for a wide range of patients. Increased treatment frequency with more than 12 dialysis hours/week, low ultrafiltration intensity, stable biochemistry, reduced medication use, and good clinical outcomes are observed.