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Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation
Author(s) -
Molnar Miklos Z.,
Ravel Vanessa,
Streja Elani,
Kovesdy Csaba P.,
Rivara Matthew B.,
Mehrotra Rajnish,
KalantarZadeh Kamyar
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14321
Subject(s) - medicine , interquartile range , home hemodialysis , dialysis , hemodialysis , proportional hazards model , cohort , kidney disease , kidney transplantation , transplantation , confidence interval , prospective cohort study , peritoneal dialysis , hazard ratio , renal replacement therapy , surgery
Objectives To compare the mortality of elderly adults with end‐stage renal disease ( ESRD ) treated with home hemodialysis ( HD ) with that of those receiving a kidney transplant ( KT x). Design Prospective cohort. Setting Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. Participants Using data from elderly adults (aged ≥65) who started home HD and underwent KT x in the US between 2007 and 2011, a 1:1 propensity score ( PS )‐matched cohort of 960 elderly adults was created, and the association between treatment modality and all‐cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event. Measurements Modality of renal replacement therapy. Results The baseline mean age ± standard deviation of the PS ‐matched individuals undergoing home HD was 71 ± 6, and that of KT x recipients was 71 ± 5, 69% of both groups were male, 81% of those undergoing home HD and 79% of KT x recipients were white, and 11% and 12%, respectively, were African American. Median follow‐up time was 205 days (interquartile range ( IQR ) 78–364 days) for those undergoing home HD and 795 days ( IQR 366–1,221 days) for KT x recipients. There were 97 deaths (20%, 253/1,000 patient‐years, 95% confidence interval ( CI ) = 207–309/1,000 patient‐years) in the home HD group and 48 deaths (10%, 45/1,000 patient‐years, 95% CI = 34–60/1,000 patient‐years) in the KT x group. Elderly adults undergoing home HD had a risk of mortality that was almost five times as high as that of KT x recipients (hazard ratio = 4.74, 95% CI = 3.25–6.91). Similar results were seen in competing risk regression analyses (subhazard ratio = 4.71, 95% CI = 3.27–6.79). Results were consistent across different types of kidney donors and subgroups divided according to various recipient characteristics. Conclusion Elderly adults with ESRD who receive a KT x have greater survival than those who undergo home HD . Further studies are needed to assess whether KT x receipt is associated with other benefits such as better quality of life and lower hospitalization rates.