Kidney transplantation prolongs survival compared with home hemodialysis

Previous studies have found that kidney failure patients on long-term dialysis tend to die earlier than patients who receive kidney transplants; however, none of these studies have considered death rates in US patients using alternative forms of dialysis such as home hemodialysis. Two such studies will be presented at ASN Kidney Week 2015 November 3¬-8 at the San Diego Convention Center in San Diego, CA.

Miklos Zsolt Molnar, MD, PhD, FEBTM, FERA, FASN (University of Tennessee Health Science Center) and his colleagues compared information on 2000 patients who started home hemodialysis with 2000 who received kidney transplants in the United States between 2007 and 2011.

Over 5 years of follow-up, home hemodialysis patients were 4-times more likely to die than kidney transplant recipients. "There was a significant interaction with race for the association of treatment modality with mortality," said Dr. Molnar. "In African Americans, mortality risk increased after the first year as the survival lines were separated only after this time-point, while in Whites the survival lines were separated from the beginning of the follow-up." He noted that additional studies are needed to understand the reasons underlying racial differences in the risk of premature death in home hemodialysis vs. kidney transplant patients.

In a second study, Dr. Molnar and his team compared mortality rates in 480 elderly (>65 years old) patients using home hemodialysis with 480 matched kidney transplant recipients. In this case, home hemodialysis patients had nearly a 5-times higher risk of dying during follow-up than kidney transplant patients. Results were consistent across different types of kidney donors and subgroups divided by various recipient characteristics.

"Further studies are needed to assess whether kidney transplant also provides better quality of life or lower hospitalization rates compared with home hemodialysis in elderly patients with end stage renal disease," said Dr. Molnar.