Intensive Home Hemodialysis Survival Comparable to Deceased Donor Kidney Transplantation

Abstract Introduction Kidney transplant remains the treatment of choice for end stage kidney disease but access to transplant is limited by a disparity between supply and demand for suitable organs. This organ shortfall has resulted in the use of a wider range of donor kidneys and, in parallel, a re-examination of potential alternative renal replacement therapies. Previous studies comparing Canadian intensive home hemodialysis with deceased donor kidney transplant in the US, reported similar survival suggesting intensive home hemodialysis might be a plausible alternative. Methods Using data from the Scientific Registry of Transplant Recipients and an experienced US-based intensive home hemodialysis program in Lynchburg, VA, we retrospectively compared mortality outcomes of a cohort of intensive home hemodialysis patients to transplant recipients within the same geographic region between October 1997 and June 2014. Results We identified 3073 transplant recipients and 116 intensive home hemodialysis patients. Living donor kidney transplantation (n=1212) had the highest survival and 47% reduction in risk of death compared to intensive home hemodialysis (hazard ratio (HR) 0.53, 95% confidence interval (CI): 0.34-0.83). Survival of intensive home hemodialysis patients did not statistically differ from that of deceased donor transplant recipients (n=1834) in adjusted analyses (HR=0.96, 95% CI: 0.62-1.48) or when exclusively compared to marginal (Kidney Donor Profile Index>85%) transplant recipients (HR=1.35, 95% CI: 0.84-2.16). Conclusion Our study showed comparable overall survival between intensive home hemodialysis and deceased donor kidney transplantation. For appropriate patients, intensive home hemodialysis could serve as bridging therapy to transplant and a tenable long-term renal replacement therapy.