Home-based dialysis tied to reduced health deterioration in elderly patients
Home-based dialysis, regardless of type, appears to reduce the risk of worsening health in older patients, according to a prospective longitudinal cohort study from New Zealand.
Researchers performed a modified Poisson regression analysis to determine the predictors of worse health status in a cohort 150 elderly patients (aged ≥65 years) receiving long-term dialysis. Patient-reported social and health characteristics were evaluated using the 36-Item Short Form Health Survey, EQ-5D and Kidney Symptom Score questionnaires, and clinical information from health records.
The main outcome was health status after 12 months of follow-up, and results showed that 35 percent of the cohort reported worse health or had died at 12 months.
Baseline variables independently associated with reduced risk of worse health status included Pacific ethnicity (relative risk [RR], 0.63; 95 percent CI, 0.53 to 0.72), greater bother on the Kidney Symptom Score (RR, 0.78; 0.62 to 0.97) and dialysis at home (haemodialysis: RR, 0.55; 0.36 to 0.83; peritoneal dialysis: RR, 0.86; 0.79 to 0.93).
On the other hand, baseline variables independently associated with increased risk of worse health status included greater social dissatisfaction (RR, 1.66; 1.27 to 2.17), lower sense of community (RR, 1.70; 1.09 to 2.64), comorbid conditions (RR, 1.70; 1.09 to 2.64), EQ-5D anxiety/depression (RR, 1.61; 1.07 to 2.42), poor/fair overall general health (RR, 1.60; 1.37 to 1.85) and longer dialysis therapy duration (RR, 1.03; 1.00 to 1.05).
Despite the small sample size and restricted study power, the present data should provide encouragement to home-dialyzing patients and their clinicians alike, researchers said.
“Should this finding be confirmed in other countries, this may lead to increased consideration by clinicians and policy makers of more patient-centred home-based dialysis treatment options for older patients with end-stage kidney disease,” they added.