Choosing Home Hemodialysis: A Critical Review of Patient Outcomes.
BACKGROUND/AIM
Home hemodialysis (HHD) has been associated with improved clinical outcomes vs. in-center HD (ICHD). The prevalence of HHD in the United States is still very low at 1.8%. This critical review compares HHD and ICHD outcomes for survival, hospitalization, cardiovascular (CV), nutrition, and quality of life (QoL).


METHODS
Of 545 publications identified, 44 were not selected after applying exclusion criteria. A systematic review of the identified publications was conducted to compare HHD to ICHD outcomes for survival, hospitalization, CV outcomes, nutrition, and QoL.


RESULTS
Regarding mortality, 10 of 13 trials reported 13-52% reduction; three trials found no differences. According to 6 studies, blood pressure and left ventricular size measurements were generally lower in HHD patients compared to similar measurements in ICHD patients. Regarding nutritional status, conflicting results were reported (8 studies); some found improved muscle mass, total protein, and body mass index in HHD vs. ICHD patients, while others found no significant differences. There were no significant differences in the rate of hospitalization between HHD and ICHD in the 6 articles reviewed. Seven studies on QoL demonstrated positive trends in HHD vs. ICHD populations.


CONCLUSIONS
Despite limitations in the current data, 66% of the publications reviewed (29/44) demonstrated improved clinical outcomes in patients who chose HHD. These include improved survival, CV, nutritional, and QoL parameters. Even though HHD may not be preferred in all patients, a review of the literature suggests that HHD should be provided as a modality choice for substantially more than the current 1.8% of HHD patients in the United States.
['Miller|Brent W|BW|', 'Himmele|Rainer|R|', 'Sawin|Dixie-Ann|DA|', 'Kim|Jeeseon|J|', 'Kossmann|Robert J|RJ|']
D002986:Clinical Trials as Topic D018572:Disease-Free Survival D005260:Female D006437:Hemodialysis, Home D006801:Humans D007676:Kidney Failure, Chronic D008297:Male D015996:Survival Rate D014481:United States
Home hemodialysis Outcomes Quality of life Mortality Cardiovascular blood pressure