Home hemodialysis cuts hospital days

By Will Boggs, MD

NEW YORK (Reuters Health) - The number of hospital days is lower for daily home hemodialysis patients than for peritoneal dialysis patients, according to a report in the American Journal of Kidney Diseases.

When kidneys fail, toxins in a patient's blood can be removed by passing the blood over membranes that allow the harmful substances to pass through and be removed. This is known as hemodialysis and, traditionally, patients requiring it had to travel several times per week to a clinic where the process can take upwards of 5 hours. In recent years, however, devices have been developed that allow hemodialysis to be performed at home.

An alternative to hemodialysis is peritoneal dialysis, a process in which fluid is instilled into the abdominal cavity and then drained after several hours, along with unwanted toxins. The advantage of peritoneal dialysis is that the patient is not tethered to a machine for hours at a time and, therefore, it can be performed at home.

"Home hemodialysis keeps patients at home, not in the hospital," Dr. Victoria A. Kumar from Southern California Permanente Medical Group in Los Angeles told Reuters Health. "Ultimately there is a cost savings when patients perform any home therapy."

Kumar and colleagues compared hospital admissions for their home hemodialysis patients with peritoneal patients who initiated training during the same period. The findings were then compared with data from the US Renal Data Service (USRDS) database.

The hospitalization rate during the study period was similar for patients treated at home with hemodialysis or peritoneal dialysis, the authors report, but the hemodialysis group had significantly fewer hospital days per year than did peritoneal dialysis patients.

Similarly, based on USRDS data, the hemodialysis patients should have had 64.8 hospital admissions and 271.8 hospital days, whereas in fact they had only 27 admissions and 130 hospital days.

Fifteen of the 22 home hemodialysis patients were still in the program at the time of the report, the investigators say, with 2 having received kidney transplants, 2 having died, and 3 having transferred to in-center hemodialysis therapy.