Hospitalization rates in daily home hemodialysis versus peritoneal dialysis patients in the United States

Background: Daily hemodialysis (DHD) is associated with improvements in hypertension, left ventricular hypertrophy, mineral metabolism, nutrition, and quality of life, but efficacy is uncertain because of potential selection bias. To reduce the influence of selection bias, we sought to compare hospital admissions for our population of DHD patients with peritoneal dialysis (PD) patients who initiated training during the same period. We also compared our hospital data with the US Renal Data Service database. Study Design: Prospective nonrandomized cohort study. Setting & Participants: 22 (16 male) DHD and 64 (33 male) PD patients who initiated training between March 2003 and September 2007 at our center and remained in our program for at least 6 months. Predictors: Dialysis modality (DHD or PD). Outcomes: Number of hospital admissions and length of stay. Results: Median age at initiation of training was 52 years (range, 33 to 76 years) for DHD patients versus 54 years (range, 21 to 82 years) for PD patients (P = 0.5), and median vintage was 23 months (range, 0 to 145 months) for DHD patients versus 0 month (range, 0 to 244 months) for PD patients (P < 0.001). Fifty percent of DHD and 56% of PD patients had a diagnosis of diabetes mellitus (P = 0.8). We observed 27 DHD and 82 PD admissions (0.68 and 0.76 admissions/patient-year, respectively) during the study period (P = 0.5). We also observed 130 DHD and 605 PD hospital days (3.3 and 5.6 days/patient-year, respectively; P < 0.001). Limitations: Patients were not randomly assigned between the study group and control group; study group was small. Conclusions: Our study suggests that despite similar patient demographics, patients treated with DHD spend fewer days in the hospital than PD patients in the United States. Although selection bias could partially explain our lower hospitalization rate, other factors, including improvements in blood pressure control, nutrition, and fewer fluctuations in dry weight, probably contributed to the stability of our patients.