Peritoneal dialysis is the most common kind of at-home dialysis, given its relative convenience and ease of use compared to hemodialysis. But now, in the largest study of its kind, a massive 5-year analysis of registry data in Australia and New Zealand for more than 11,000 patients, researchers have found that patient survival rates are significantly higher with home hemodialysis than with peritoneal dialysis.
During peritoneal dialysis, blood vessels in the abdominal lining substitute for the kidneys with the help of a fluid, or dialysate, which flows into and out of the peritoneal space. Hemodialysis, which involves the removal of blood from the patient to filter it of impurities, is the standard in the clinical setting. At-home hemodialysis options are becoming more viable as they become increasingly easy to use.
The latest data from the Incident Cohort Study by the Australian and New Zealand Dialysis and Transplantation Registry shows that the 5-year survival rate for at-home hemodialysis is 85% while the survival rate for peritoneal dialysis patients is just 44%. That makes the risk of death a whopping 66% lower for hemodialysis.
"These data clearly show that excellent long-term survival can be achieved in patients that are prescribed home hemodialysis within 90 days of starting maintenance dialysis," Dr. Eric Weinhandl, epidemiologist and lead investigator in studies on home dialysis clinical outcomes said in a statement from at-home hemodialysis player NxStage ($NXTM) that touted the data.
"Interestingly, the survival advantage of HHD over PD was evident in multiple frames, including younger and older patients, non-diabetics and diabetics, and early and late follow-up," he added.
The study reviewed data from 2000 to 2012 and included 10,710 at-home peritoneal dialysis patients and 706 at-home hemodialysis patients. That extreme skew toward peritoneal dialysis use is also evident in the U.S., where only about 2% of dialysis patients employ at-home hemodialysis versus about 9% using peritoneal dialysis in the home care setting.
In December, NxStage gained FDA clearance for nocturnal hemodialysis its System One, which it deems the first and only portable hemodialysis system cleared specifically for at-home and nighttime use. The company was up 1% in early trading on the study news.
"This strong clinical data backs the efficacy of HHD (home hemodialysis) and affirms the results of recent studies," said NxStage President Joe Turk in a statement. "These results further reinforce the need for clinicians to consider HHD as a first strategy for incident patients, not just when PD (peritoneal dialysis) fails."
At-home hemodialysis options are also available from diabetes devicemaker Baxter ($BAX), although it's focused largely on peritoneal dialysis for home users.
Earlier this month, startup Outset Medical said it had raised $91 million to help it get its Tablo hemodialysis system through a pivotal U.S. clinical trial for at-home use and to launch it in dialysis clinics, where it's already FDA-approved for use. In addition, last month Deerfield Management put $10 million into startup Vital Access, which has an FDA-cleared implant to make vascular access for hemodialysis easier--including potentially for at-home users.
- here is the study
- and the NxStage release about the study