Study Finds Home Dialysis as Good as Hemodialysis at Centers09/28/10
TUESDAY, Sept. 28 (HealthDay News) -- Patients with end-stage
kidney disease who have dialysis at home fare just as well as their
counterparts who do hemodialysis, which is traditionally performed
in a hospital or dialysis center, new research shows.
"This is the first demonstration with a follow-up for up to five years," said Dr. Rajnish Mehrotra, lead author of the study that is published online Sept. 27 in the Archives of Internal Medicine. "Not only was there no difference, the improvements in survival have been greater for patients who do dialysis at home."
Yet patients seem loathe to pick the at-home option, known as
peritoneal dialysis, even if they're aware of its existence, finds
another study in the same issue of the journal.
And, as an accompanying editorial points out, the proportion of
Americans using peritoneal dialysis plummeted from 14.4 percent in
1995 to about 7 percent in 2007.
Both forms of dialysis essentially act as replacement kidneys,
filtering and cleaning the blood of toxins, explained Dr. Martin
Zand, medical director of the kidney and pancreas transplant
programs at the University of Rochester Medical Center in
For peritoneal dialysis, fluid is passed into the abdomen via a
catheter. The body's own blood vessels then act as the filter. But
patients have to be able to lift 2 liters of fluid at a time and
hook it up to a pole, and to do this several times a day, Zand
But hemodialysis (which can be done at home, though it takes up
huge volumes of water) is generally necessary only a few times a
The first study analyzed national data on 620,020 patients who
began hemodialysis and 64,406 patients who began peritoneal
dialysis in three time periods: 1996-1998, 1999-2001 and
Although patients receiving peritoneal dialysis in the earlier
periods had a slightly higher risk of death than those on
hemodialysis, that difference had disappeared by the later time
period, with those on hemodialysis living an average of 38.4 months
and those on peritoneal dialysis living an average of 36.6
The second study also looked at a national database of patients,
this time to discover if patients who received information on
peritoneal dialysis were more likely to actually choose this
Nancy Kutner and colleagues found that although almost
two-thirds (61 percent) of patients said they had discussed
peritoneal dialysis with their health-care provider, only about 11
percent actually chose this option.
Rates of people preferring hemodialysis over peritoneal dialysis
differed somewhat depending on which dialysis company owned the
center they were using.
The researchers, from Emory University in Atlanta, also found
that patients on hemodialysis were more likely to be black and
living alone, while those on peritoneal dialysis were more likely
to be high school graduates and to be working.
Any number of reasons could explain the disparity.
Peritoneal dialysis is a better option for people living in
remote locations or who travel a lot. "There's more freedom," Zand
said. But being asked to take charge of your own dialysis could
feel like being asked to pilot a plane.
"The prospect of going on dialysis is scary enough in itself. Nobody ever says 'When can I start?'" Zand said. "It's often a very daunting prospect for people."
But in previous research, Mehrotra found that up to one-half of
patients who are given the choice will go with peritoneal dialysis,
indicating that the quality of patient education matters.
"We need to do a better job of educating people of the advantages of peritoneal," said Zand, who also pointed out that many nephrologists are pushing for a move to this modality. "There's a wide variation in the quality of the information the patients are given and also the enthusiasm of the person actually giving that information."
The fact that Medicare just started reimbursing physicians for
patient education may help tip the balance, added Mehrotra, who is
an associate chief of the division of nephrology at Harbor-UCLA
Medical Center. "Now physicians can get reimbursed for patient
Mehrotra's study was funded by Baxter Health Care and the U.S.
National Institutes of Health (NIH). The study by Kutner and
colleagues was funded solely by the NIH.
U.S. National Library of Medicine has more
information on the two types of dialysis.
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