Survival on home dialysis in New Zealand.

<h4>Background</h4>New Zealand (NZ) has a high prevalence of both peritoneal dialysis (PD) and home haemodialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous co...

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Autores principales:	Mark R Marshall, Rachael C Walker, Kevan R Polkinghorne, Kelvin L Lynn
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8f78c1b922a043f3b35bb345572e0e06
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spelling	oai:doaj.org-article:8f78c1b922a043f3b35bb345572e0e062021-11-18T08:20:18ZSurvival on home dialysis in New Zealand.1932-620310.1371/journal.pone.0096847https://doaj.org/article/8f78c1b922a043f3b35bb345572e0e062014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24806458/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>New Zealand (NZ) has a high prevalence of both peritoneal dialysis (PD) and home haemodialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities.<h4>Methods</h4>We analysed survival by time-varying dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression.<h4>Results</h4>We modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on home HD are younger and healthier. Compared to facility HD, home dialysis (as a unified category) associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period (<3 years) that is offset by a 33% greater mortality risk in the late period (>3 years), with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era.<h4>Conclusion</h4>Our study supports the culture of home dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase.Mark R MarshallRachael C WalkerKevan R PolkinghorneKelvin L LynnPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 5, p e96847 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mark R Marshall Rachael C Walker Kevan R Polkinghorne Kelvin L Lynn Survival on home dialysis in New Zealand.
description	<h4>Background</h4>New Zealand (NZ) has a high prevalence of both peritoneal dialysis (PD) and home haemodialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities.<h4>Methods</h4>We analysed survival by time-varying dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression.<h4>Results</h4>We modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on home HD are younger and healthier. Compared to facility HD, home dialysis (as a unified category) associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period (<3 years) that is offset by a 33% greater mortality risk in the late period (>3 years), with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era.<h4>Conclusion</h4>Our study supports the culture of home dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase.
format	article
author	Mark R Marshall Rachael C Walker Kevan R Polkinghorne Kelvin L Lynn
author_facet	Mark R Marshall Rachael C Walker Kevan R Polkinghorne Kelvin L Lynn
author_sort	Mark R Marshall
title	Survival on home dialysis in New Zealand.
title_short	Survival on home dialysis in New Zealand.
title_full	Survival on home dialysis in New Zealand.
title_fullStr	Survival on home dialysis in New Zealand.
title_full_unstemmed	Survival on home dialysis in New Zealand.
title_sort	survival on home dialysis in new zealand.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/8f78c1b922a043f3b35bb345572e0e06
work_keys_str_mv	AT markrmarshall survivalonhomedialysisinnewzealand AT rachaelcwalker survivalonhomedialysisinnewzealand AT kevanrpolkinghorne survivalonhomedialysisinnewzealand AT kelvinllynn survivalonhomedialysisinnewzealand
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Survival on home dialysis in New Zealand.

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