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Night Home Hemodialysis shown to be as good
as transplant in treating Kidney Failure
Newswise — For the first time, it has been
shown that patients who receive night home
hemodialysis live just as long as those who
receive kidney transplants from deceased
donors.
In a study entitled, “Survival among
nocturnal home hemodialysis patients
compared to kidney transplant recipients,”
published in the international September
issue of Nephrology Dialysis
Transplantation, a total of 1,239
patients were followed for up to 12 years.
Night
home hemodialysis patients were compared to
patients who received either a deceased
donor kidney transplant or a living donor
kidney transplant.
The study found that the survival between
night home dialysis patients and those who
received kidney transplants from deceased
donors was comparable, while the survival of
the patients who received a transplant from
a living kidney donor was better than both
the other groups.
These results suggest that night home
hemodialysis, an intensive dialysis of six
to eight hour sessions for up to seven times
a week, may be a “bridge to transplant” or a
“suitable alternative” to transplant should
a patient be too high risk for a transplant
or not be able to get a living or deceased
donor as the organ shortage continues.
Night home hemodialysis patients were from
the Toronto General and Humber River
Regional Hospitals, both hospitals together
representing the largest and longest
established group of such patients
world-wide.
“This study allows me to actually answer
what my patients have been asking me for
over a decade: ‘What does night home
hemodialysis mean for my life span?’ I can
now tell them that this specific dialysis
option is as good as getting a transplant
from a deceased donor,” says Dr. Christopher
Chan, Medical Director of Home Hemodialysis
at Toronto General Hospital, University
Health Network, the R. Fraser Elliott Chair
in Home Dialysis and Associate Professor,
University of Toronto.
Until this study, there has been no
long-term data on night home hemodialysis
patient survival, or on how this type of
treatment compares to transplantation.
In the study, night home hemodialysis
patients’ data was carefully matched with
deceased and living donor kidney
transplantation mortality data from the U.S.
Renal Data System on characteristics such as
age, race, diabetic status and duration of
treatment with conventional in-centre
dialysis prior to treatment.
The proportion of deaths in each group was
then measured, with final figures of 14.7%
for night home hemodialysis patients; 14.3%
for patients with transplants from deceased
donors; and 8.5% for patients with
transplants from living donors.
These results diverge from the evidence to
date that dialysis is inferior to
transplantation, pointed out Dr. Chan,
adding that there is much benefit to be
gained by long, frequent dialysis.
Florence Tewogbade, 27, has been on home
hemodialysis since April 2008, after trying
conventional dialysis. “It has changed my
life,” she said.
“I can now work, go to school, look forward
to a future and be self-reliant.” Florence
was on the transplant waiting list in 2004,
but her living donor was found to be
ineligible.
Florence says that she would have had to
wait about 10 years for a kidney from a
deceased donor because of her specific risk
factors for receiving a transplant.
“I always thought that transplant was the
only option, so I didn’t consider home
hemodialysis,” she said.
“I thought I couldn’t do it. But here I am,
doing it, and living a normal life.”
Other researchers involved in the study
include Robert Pauly, University of Alberta
Hospital, John Gill and Caren Rose, St.
Paul’s Hospital, UBC, Reem Asad, TGH, Anne
Cherry, UHN, Andreas Pierratos, Humber River
Regional Hospital.
This study did not require any external
funding.
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