- Email: [email protected]
Survival Comparisons in Home Dialysis: Where You Finish Depends on Where You Start
Editorial Survival Comparisons in Home Dialysis: Where You Finish Depends on Where You Start Related Article, p. 98
I
n the United States, changes in dialysis reimbursement have resulted in considerable growth in home dialysis over the past 4 years1 in the face of historically declining utilization.2 Traditionally, clinicians have regarded peritoneal dialysis (PD) as the most appropriate initial home dialysis therapy.3 However, in recent years, home hemodialysis (HHD) has emerged as an increasingly feasible and well-tolerated modality. The gap between HHD and PD has begun to narrow in terms of treatment complexity, and measures of the intrusiveness of disease symptoms and the therapy itself are similar between both modalities.4 With everincreasing treatment options and technologies for home-based dialysis therapy, there has been increased interest in comparing outcomes across these modalities. The available literature comparing PD and HHD initially emerged from Australia and New Zealand, where Marshall et al5 showed that compared with patients treated with conventional hemodialysis (HD), those using HHD had a 49% lower mortality rate. In contrast, patients performing PD had similar mortality to the conventional HD cohort. However, Marshall et al noted that the HHD group comprised a younger population with fewer comorbid conditions compared with those treated by other dialysis modalities.5 In a similar analysis comparing PD and HHD patients from the US Renal Data System (USRDS), Suri et al6 found that propensity score– matched HHD patients had a 27% lower rate of cardiovascular-, access-, and infection-related hospitalization. However, this finding was from a population in which .75% of patients in each group had an end-stage renal disease (ESRD) vintage of 12 months or longer. Subsequently, Nadeau-Fredette et al7 performed a direct comparison of incident HHD and PD patients in Australia and New Zealand and demonstrated that after propensity score matching, HHD still carried a 48% lower risk for death. In this issue of AJKD, Weinhandl et al8 report their findings on the differences in outcomes between PD and HHD. They selected a cohort of patients who used NxStage System One for HHD for whom data had been prospectively collected. Controls were derived from PD patients in the USRDS database. The HHD patients were younger, had a longer mean duration of ESRD at the start of HHD, were less likely to have diabetes-related ESRD, and were more Am J Kidney Dis. 2016;67(1):13-15
likely to be eligible for kidney transplantation than the overall PD cohort. Thus, Weinhandl and colleagues used propensity score matching to generate 2 similar cohorts, albeit at the expense of removing .90% of PD patients from the analysis. The study found a 20% lower overall mortality rate and 8% lower hospital admission rate for HHD, but no difference when the analysis was restricted to the 1,368 patients in each group who initiated HHD and PD therapy within 6 months of ESRD onset. Technique failure was significantly lower in HHD regardless of ESRD vintage at home dialysis therapy initiation. This study reaffirms available data demonstrating that HHD patients generally have lower rates of mortality and technique failure, especially among patients who already have long ESRD vintage, while validating these findings in the US population. The Weinhandl et al study shares many limitations with its predecessors, including nonvalidated definitions for outcomes such as technique failure and lack of information regarding dialysis dose and other important confounders, including residual kidney function and hemodialysis vascular access type. The authors speculate that the similar mortality and admission rates for patients with ESRD vintage less than 6 months may be due to higher residual kidney function among PD patients. The influence of preserved residual kidney function on mortality in both PD and HD is well established9,10; it has also been shown that patients undergoing frequent HD have a more rapid decline in residual kidney function for reasons that have not yet been explained in full.11 Meanwhile, the lack of assessment of the influence of access type on primary and secondary outcomes is important because access type is a well-known effect modifier of outcomes by dialysis modality. In particular, the use of central venous catheters (CVCs) has been shown to be associated with higher all-cause mortality in conventional hemodialysis12-14 and, more recently, in HHD.15 How the outcomes of HHD patients with CVCs compare with those of PD patients may be an important consideration. Another limitation is the lack of information about the scope and
Address correspondence to Jeffrey Perl, MD, SM, St. Michael’s Hospital, 3-060 Shuter Wing, 30 Bond St, Toronto, Ontario, Canada M5B 1W8. E-mail: [email protected] Ó 2016 by the National Kidney Foundation, Inc. 0272-6386 http://dx.doi.org/10.1053/j.ajkd.2015.10.001 13
Misra, Bargman, and Perl
capture of facilities and patients in the NxStage One database used by Weinhandl et al relative to the entire population of NxStage One users in the United States, which may challenge the generalizability of the findings. Outside of a propensity-matched rarified cohort, it is clear that PD and HHD patients are fundamentally different from the start, further complicating the comparisons we can make between the 2 groups. HHD tends to attract younger healthier patients. In addition, unlike their PD counterparts who have significantly higher incident use, HHD patients are more likely to have used another renal replacement therapy (RRT) modality.16 Although it would be ideal to compare PD and HHD with randomized controlled trials, lessons learned from attempts to randomly assign patients to conventional HD vs PD therapy have taught us the importance of patient preferences in dialysis modality selection and the near impossibility of random allocation of patients to a particular dialysis modality.17 Where then does that leave us? Clearly, comparing outcomes by home dialysis modality depends on where you start. Improved mortality and reduced hospitalization and technique failure in HHD relative to PD may tempt us to think of the latter as being overall superior. However, we must consider that these more favorable outcomes have been observed in a population with a long ESRD vintage. Equally as important is the finding from Weinhandl et al that outcomes are similar between PD and HHD when started soon after ESRD onset. In their randomized controlled trial of frequent HHD, Rocco et al18 argued that the lack of benefit observed in mortality and cardiac function might be attributable to the recruitment of a largely incident patient population because the composition of the study population may have modified the potential benefit of frequent HHD on patient outcomes. Retrospective observational studies have demonstrated that patients who initiate RRT with PD and transfer to HHD have similar outcomes to incident HHD patients in terms of patient and technique failure.19,20 In contrast, transitioning to PD after initiating a different form of RRT has been shown to carry an elevated risk for PD technique failure, residual kidney function decline, peritonitis, and mortality.21-24 This is particularly important when considering the results of Weinhandl and colleagues because the mean ESRD vintage for PD patients in the group with 61 months’ ESRD duration was in excess of 60 months. Given such findings, many members of the nephrology community have begun advocating for an “integrated home dialysis” model of RRT, whereby patients initially receive PD and are subsequently 14
transitioned to HHD. Early PD carries the advantages of preserving residual kidney function, reducing lifetime demand for vascular access, and having the ability to prescribe incremental PD, which may be more palatable to a patient with incident ESRD.20 A “PD first” approach may be particularly attractive for patients with limited options for vascular access, especially those who would otherwise be CVC dependent. This is especially salient given the finding of Weinhandl et al that the higher rates of hospitalization in the HHD population result from sepsis and bacteremia, which may be due in part to CVC use (though information to corroborate this supposition was not available). Initial use of PD may better acclimatize patients to home dialysis, and as a result, may ultimately enhance downstream HHD uptake. Moreover, in the present study (and similar to previous observations comparing PD and conventional HD cohorts), on-treatment mortality differences between PD and HHD patients seemed to favor the HHD cohort even more so after the first 3 years of therapy; this result may indicate the need for more timely transfers from PD in a subset of patients. In this regard, a timely home-to-home approach thus stands to capitalize on the benefits of the 2 complementary forms of RRT while minimizing their individual limitations. In conclusion, Weinhandl et al found that relative to PD, HHD is associated with reduced mortality, technique failure, and hospitalization in older vintage patients; however, these intermodality differences are nearly erased in incident patients, findings that are important for patients eligible for both therapies. But how many of these patients really exist? It is important to note that the current study looked at patients in the United States, where only 0.4% of incident dialysis patients are treated with HHD.1 We must therefore strive to better identify all patients eligible for home dialysis therapy while providing the important and necessary tools that empower these individuals to choose the appropriate home dialysis therapy—and at the appropriate time. Such an approach would comprehensively examine strategies to eliminate any barriers to the adoption of either therapy. In this regard, important end points such as patient satisfaction and quality of life may be more important than the differences in mortality described in observational studies, which have considerable bias. Although we agree with the initial comment made by Weinhandl and colleagues that comparisons between conventional HD and PD are “irrelevant,” it is not because we are comparing the wrong populations of patients and that we ought to restrict outcome comparisons to home dialysis patients alone; instead, it is because we are not focusing on all the right outcomes, namely the importance of Am J Kidney Dis. 2016;67(1):13-15
Editorial
improving patient-reported outcomes in delivering high-quality ESRD care. Paraish S. Misra, MD Joanne M. Bargman, MD Jeffrey Perl, MD, SM University of Toronto, Toronto, Canada
ACKNOWLEDGEMENTS Support: None. Financial Disclosure: Dr Bargman has served as a consultant for Baxter Healthcare and received speaking honoraria from DaVita Healthcare Partners. Dr Perl has received consulting fees from Amgen, Canada Baxter Healthcare, Otsuka, Janssen Ortho Shire, and Takeda and speaking honoraria from Baxter Healthcare, Amgen Canada, and DaVita Healthcare Partners. He also has received research support from Baxter Healthcare and salary support from Arbor Research Collaborative for Health. Dr Misra declares that he has no relevant financial interests.
REFERENCES 1. Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: epidemiology of kidney disease in the United States [abstract]. Am J Kidney Dis. 2015;65:A7. 2. Mehrotra R, Kermah D, Fried L, et al. Chronic peritoneal dialysis in the United States: declining utilization despite improving outcomes. J Am Soc Nephrol. 2007;18:2781-2788. 3. Ledebo I, Ronco C. The best dialysis therapy? Results from an international survey among nephrology professionals. NDT Plus. 2008;1:403-408. 4. Fong E, Bargman JM, Chan CT. Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis. Clin J Am Soc Nephrol. 2007;2:1195-1200. 5. Marshall MR, Hawley CM, Kerr PG, et al. Home hemodialysis and mortality risk in Australian and New Zealand populations. Am J Kidney Dis. 2011;58:782-793. 6. Suri RS, Li L, Nesrallah GE. The risk of hospitalization and modality failure with home dialysis. Kidney Int. 2015;88: 360-368. 7. Nadeau-Fredette AC, Hawley CM, Pascoe EM, et al. An incident cohort study comparing survival on home hemodialysis and peritoneal dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol. 2015;10:1397-1407. 8. Weinhandl ED, Gilbertson DT, Collins AJ. Mortality, hospitalization, and technique failure in daily home hemodialysis and matched peritoneal dialysis patients: a matched cohort study. Am J Kidney Dis. 2016;67(1):98-110. 9. Bargman JM, Thorpe KE, Churchill DN, the CANUSA Peritoneal Dialysis Study Group. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA Study. J Am Soc Nephrol. 2001;12:2158-2162.
Am J Kidney Dis. 2016;67(1):13-15
10. Shemin D, Bostom AG, Laliberty P, Dworkin LD. Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis. 2001;38:85-90. 11. Daugirdas JT, Greene T, Rocco MV, et al. Effect of frequent hemodialysis on residual kidney function. Kidney Int. 2013;83:949-958. 12. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. 2001;60:1443-1451. 13. Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among hemodialysis patients. Kidney Int. 2002;62:620-626. 14. Perl J, Wald R, McFarlane P, et al. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol. 2011;22:1113-1121. 15. Perl J, Nessim SJ, Moist L, et al. Vascular access type and patient and technique survival in home hemodialysis patients: the Canadian Organ Replacement Register [published online ahead of print September 16, 2015]. Am J Kidney Dis. http://dx.doi.org/ 10.1053/j.ajkd.2015.07.032. 16. Rioux JP, Bargman JM, Chan CT. Systematic differences among patients initiated on home haemodialysis and peritoneal dialysis: the fallacy of potential competition. Nephrol Dial Transplant. 2010;25:2364-2367. 17. Korevaar JC, Feith GW, Dekker FW, et al. Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int. 2003;64:2222-2228. 18. Rocco MV, Lockridge RS Jr, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80:1080-1091. 19. Nadeau-Fredette AC, Bargman JM, Chan CT. Clinical outcome of home hemodialysis in patients with previous peritoneal dialysis exposure: evaluation of the integrated home dialysis model. Perit Dial Int. 2015;35:316-323. 20. Nadeau-Fredette AC, Chan CT, Cho Y, et al. Outcomes of integrated home dialysis care: a multi-centre, multi-national registry study. Nephrol Dial Transplant. 2015;30(11): 1897-1904. 21. Nessim SJ, Bargman JM, Jassal SV, Oliver MJ, Na Y, Perl J. The impact of transfer from hemodialysis on peritoneal dialysis technique survival. Perit Dial Int. 2015;35:297-305. 22. Nessim SJ, Bargman JM, Austin PC, Nisenbaum R, Jassal SV. Predictors of peritonitis in patients on peritoneal dialysis: results of a large, prospective Canadian database. Clin J Am Soc Nephrol. 2009;4:1195-1200. 23. Kim DJ, Park JA, Huh W, Kim YG, Oh HY. The effect of hemodialysis during break-in period on residual renal function in CAPD patients. Perit Dial Int. 2000;20:784-785. 24. Lobbedez T, Verger C, Ryckelynck JP, Fabre E, Evans D. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol. 2012;7:612-618.
15
I
n the United States, changes in dialysis reimbursement have resulted in considerable growth in home dialysis over the past 4 years1 in the face of historically declining utilization.2 Traditionally, clinicians have regarded peritoneal dialysis (PD) as the most appropriate initial home dialysis therapy.3 However, in recent years, home hemodialysis (HHD) has emerged as an increasingly feasible and well-tolerated modality. The gap between HHD and PD has begun to narrow in terms of treatment complexity, and measures of the intrusiveness of disease symptoms and the therapy itself are similar between both modalities.4 With everincreasing treatment options and technologies for home-based dialysis therapy, there has been increased interest in comparing outcomes across these modalities. The available literature comparing PD and HHD initially emerged from Australia and New Zealand, where Marshall et al5 showed that compared with patients treated with conventional hemodialysis (HD), those using HHD had a 49% lower mortality rate. In contrast, patients performing PD had similar mortality to the conventional HD cohort. However, Marshall et al noted that the HHD group comprised a younger population with fewer comorbid conditions compared with those treated by other dialysis modalities.5 In a similar analysis comparing PD and HHD patients from the US Renal Data System (USRDS), Suri et al6 found that propensity score– matched HHD patients had a 27% lower rate of cardiovascular-, access-, and infection-related hospitalization. However, this finding was from a population in which .75% of patients in each group had an end-stage renal disease (ESRD) vintage of 12 months or longer. Subsequently, Nadeau-Fredette et al7 performed a direct comparison of incident HHD and PD patients in Australia and New Zealand and demonstrated that after propensity score matching, HHD still carried a 48% lower risk for death. In this issue of AJKD, Weinhandl et al8 report their findings on the differences in outcomes between PD and HHD. They selected a cohort of patients who used NxStage System One for HHD for whom data had been prospectively collected. Controls were derived from PD patients in the USRDS database. The HHD patients were younger, had a longer mean duration of ESRD at the start of HHD, were less likely to have diabetes-related ESRD, and were more Am J Kidney Dis. 2016;67(1):13-15
likely to be eligible for kidney transplantation than the overall PD cohort. Thus, Weinhandl and colleagues used propensity score matching to generate 2 similar cohorts, albeit at the expense of removing .90% of PD patients from the analysis. The study found a 20% lower overall mortality rate and 8% lower hospital admission rate for HHD, but no difference when the analysis was restricted to the 1,368 patients in each group who initiated HHD and PD therapy within 6 months of ESRD onset. Technique failure was significantly lower in HHD regardless of ESRD vintage at home dialysis therapy initiation. This study reaffirms available data demonstrating that HHD patients generally have lower rates of mortality and technique failure, especially among patients who already have long ESRD vintage, while validating these findings in the US population. The Weinhandl et al study shares many limitations with its predecessors, including nonvalidated definitions for outcomes such as technique failure and lack of information regarding dialysis dose and other important confounders, including residual kidney function and hemodialysis vascular access type. The authors speculate that the similar mortality and admission rates for patients with ESRD vintage less than 6 months may be due to higher residual kidney function among PD patients. The influence of preserved residual kidney function on mortality in both PD and HD is well established9,10; it has also been shown that patients undergoing frequent HD have a more rapid decline in residual kidney function for reasons that have not yet been explained in full.11 Meanwhile, the lack of assessment of the influence of access type on primary and secondary outcomes is important because access type is a well-known effect modifier of outcomes by dialysis modality. In particular, the use of central venous catheters (CVCs) has been shown to be associated with higher all-cause mortality in conventional hemodialysis12-14 and, more recently, in HHD.15 How the outcomes of HHD patients with CVCs compare with those of PD patients may be an important consideration. Another limitation is the lack of information about the scope and
Address correspondence to Jeffrey Perl, MD, SM, St. Michael’s Hospital, 3-060 Shuter Wing, 30 Bond St, Toronto, Ontario, Canada M5B 1W8. E-mail: [email protected] Ó 2016 by the National Kidney Foundation, Inc. 0272-6386 http://dx.doi.org/10.1053/j.ajkd.2015.10.001 13
Misra, Bargman, and Perl
capture of facilities and patients in the NxStage One database used by Weinhandl et al relative to the entire population of NxStage One users in the United States, which may challenge the generalizability of the findings. Outside of a propensity-matched rarified cohort, it is clear that PD and HHD patients are fundamentally different from the start, further complicating the comparisons we can make between the 2 groups. HHD tends to attract younger healthier patients. In addition, unlike their PD counterparts who have significantly higher incident use, HHD patients are more likely to have used another renal replacement therapy (RRT) modality.16 Although it would be ideal to compare PD and HHD with randomized controlled trials, lessons learned from attempts to randomly assign patients to conventional HD vs PD therapy have taught us the importance of patient preferences in dialysis modality selection and the near impossibility of random allocation of patients to a particular dialysis modality.17 Where then does that leave us? Clearly, comparing outcomes by home dialysis modality depends on where you start. Improved mortality and reduced hospitalization and technique failure in HHD relative to PD may tempt us to think of the latter as being overall superior. However, we must consider that these more favorable outcomes have been observed in a population with a long ESRD vintage. Equally as important is the finding from Weinhandl et al that outcomes are similar between PD and HHD when started soon after ESRD onset. In their randomized controlled trial of frequent HHD, Rocco et al18 argued that the lack of benefit observed in mortality and cardiac function might be attributable to the recruitment of a largely incident patient population because the composition of the study population may have modified the potential benefit of frequent HHD on patient outcomes. Retrospective observational studies have demonstrated that patients who initiate RRT with PD and transfer to HHD have similar outcomes to incident HHD patients in terms of patient and technique failure.19,20 In contrast, transitioning to PD after initiating a different form of RRT has been shown to carry an elevated risk for PD technique failure, residual kidney function decline, peritonitis, and mortality.21-24 This is particularly important when considering the results of Weinhandl and colleagues because the mean ESRD vintage for PD patients in the group with 61 months’ ESRD duration was in excess of 60 months. Given such findings, many members of the nephrology community have begun advocating for an “integrated home dialysis” model of RRT, whereby patients initially receive PD and are subsequently 14
transitioned to HHD. Early PD carries the advantages of preserving residual kidney function, reducing lifetime demand for vascular access, and having the ability to prescribe incremental PD, which may be more palatable to a patient with incident ESRD.20 A “PD first” approach may be particularly attractive for patients with limited options for vascular access, especially those who would otherwise be CVC dependent. This is especially salient given the finding of Weinhandl et al that the higher rates of hospitalization in the HHD population result from sepsis and bacteremia, which may be due in part to CVC use (though information to corroborate this supposition was not available). Initial use of PD may better acclimatize patients to home dialysis, and as a result, may ultimately enhance downstream HHD uptake. Moreover, in the present study (and similar to previous observations comparing PD and conventional HD cohorts), on-treatment mortality differences between PD and HHD patients seemed to favor the HHD cohort even more so after the first 3 years of therapy; this result may indicate the need for more timely transfers from PD in a subset of patients. In this regard, a timely home-to-home approach thus stands to capitalize on the benefits of the 2 complementary forms of RRT while minimizing their individual limitations. In conclusion, Weinhandl et al found that relative to PD, HHD is associated with reduced mortality, technique failure, and hospitalization in older vintage patients; however, these intermodality differences are nearly erased in incident patients, findings that are important for patients eligible for both therapies. But how many of these patients really exist? It is important to note that the current study looked at patients in the United States, where only 0.4% of incident dialysis patients are treated with HHD.1 We must therefore strive to better identify all patients eligible for home dialysis therapy while providing the important and necessary tools that empower these individuals to choose the appropriate home dialysis therapy—and at the appropriate time. Such an approach would comprehensively examine strategies to eliminate any barriers to the adoption of either therapy. In this regard, important end points such as patient satisfaction and quality of life may be more important than the differences in mortality described in observational studies, which have considerable bias. Although we agree with the initial comment made by Weinhandl and colleagues that comparisons between conventional HD and PD are “irrelevant,” it is not because we are comparing the wrong populations of patients and that we ought to restrict outcome comparisons to home dialysis patients alone; instead, it is because we are not focusing on all the right outcomes, namely the importance of Am J Kidney Dis. 2016;67(1):13-15
Editorial
improving patient-reported outcomes in delivering high-quality ESRD care. Paraish S. Misra, MD Joanne M. Bargman, MD Jeffrey Perl, MD, SM University of Toronto, Toronto, Canada
ACKNOWLEDGEMENTS Support: None. Financial Disclosure: Dr Bargman has served as a consultant for Baxter Healthcare and received speaking honoraria from DaVita Healthcare Partners. Dr Perl has received consulting fees from Amgen, Canada Baxter Healthcare, Otsuka, Janssen Ortho Shire, and Takeda and speaking honoraria from Baxter Healthcare, Amgen Canada, and DaVita Healthcare Partners. He also has received research support from Baxter Healthcare and salary support from Arbor Research Collaborative for Health. Dr Misra declares that he has no relevant financial interests.
REFERENCES 1. Saran R, Li Y, Robinson B, et al. US Renal Data System 2014 Annual Data Report: epidemiology of kidney disease in the United States [abstract]. Am J Kidney Dis. 2015;65:A7. 2. Mehrotra R, Kermah D, Fried L, et al. Chronic peritoneal dialysis in the United States: declining utilization despite improving outcomes. J Am Soc Nephrol. 2007;18:2781-2788. 3. Ledebo I, Ronco C. The best dialysis therapy? Results from an international survey among nephrology professionals. NDT Plus. 2008;1:403-408. 4. Fong E, Bargman JM, Chan CT. Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis. Clin J Am Soc Nephrol. 2007;2:1195-1200. 5. Marshall MR, Hawley CM, Kerr PG, et al. Home hemodialysis and mortality risk in Australian and New Zealand populations. Am J Kidney Dis. 2011;58:782-793. 6. Suri RS, Li L, Nesrallah GE. The risk of hospitalization and modality failure with home dialysis. Kidney Int. 2015;88: 360-368. 7. Nadeau-Fredette AC, Hawley CM, Pascoe EM, et al. An incident cohort study comparing survival on home hemodialysis and peritoneal dialysis (Australia and New Zealand Dialysis and Transplantation Registry). Clin J Am Soc Nephrol. 2015;10:1397-1407. 8. Weinhandl ED, Gilbertson DT, Collins AJ. Mortality, hospitalization, and technique failure in daily home hemodialysis and matched peritoneal dialysis patients: a matched cohort study. Am J Kidney Dis. 2016;67(1):98-110. 9. Bargman JM, Thorpe KE, Churchill DN, the CANUSA Peritoneal Dialysis Study Group. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA Study. J Am Soc Nephrol. 2001;12:2158-2162.
Am J Kidney Dis. 2016;67(1):13-15
10. Shemin D, Bostom AG, Laliberty P, Dworkin LD. Residual renal function and mortality risk in hemodialysis patients. Am J Kidney Dis. 2001;38:85-90. 11. Daugirdas JT, Greene T, Rocco MV, et al. Effect of frequent hemodialysis on residual kidney function. Kidney Int. 2013;83:949-958. 12. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. 2001;60:1443-1451. 13. Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among hemodialysis patients. Kidney Int. 2002;62:620-626. 14. Perl J, Wald R, McFarlane P, et al. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol. 2011;22:1113-1121. 15. Perl J, Nessim SJ, Moist L, et al. Vascular access type and patient and technique survival in home hemodialysis patients: the Canadian Organ Replacement Register [published online ahead of print September 16, 2015]. Am J Kidney Dis. http://dx.doi.org/ 10.1053/j.ajkd.2015.07.032. 16. Rioux JP, Bargman JM, Chan CT. Systematic differences among patients initiated on home haemodialysis and peritoneal dialysis: the fallacy of potential competition. Nephrol Dial Transplant. 2010;25:2364-2367. 17. Korevaar JC, Feith GW, Dekker FW, et al. Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int. 2003;64:2222-2228. 18. Rocco MV, Lockridge RS Jr, Beck GJ, et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80:1080-1091. 19. Nadeau-Fredette AC, Bargman JM, Chan CT. Clinical outcome of home hemodialysis in patients with previous peritoneal dialysis exposure: evaluation of the integrated home dialysis model. Perit Dial Int. 2015;35:316-323. 20. Nadeau-Fredette AC, Chan CT, Cho Y, et al. Outcomes of integrated home dialysis care: a multi-centre, multi-national registry study. Nephrol Dial Transplant. 2015;30(11): 1897-1904. 21. Nessim SJ, Bargman JM, Jassal SV, Oliver MJ, Na Y, Perl J. The impact of transfer from hemodialysis on peritoneal dialysis technique survival. Perit Dial Int. 2015;35:297-305. 22. Nessim SJ, Bargman JM, Austin PC, Nisenbaum R, Jassal SV. Predictors of peritonitis in patients on peritoneal dialysis: results of a large, prospective Canadian database. Clin J Am Soc Nephrol. 2009;4:1195-1200. 23. Kim DJ, Park JA, Huh W, Kim YG, Oh HY. The effect of hemodialysis during break-in period on residual renal function in CAPD patients. Perit Dial Int. 2000;20:784-785. 24. Lobbedez T, Verger C, Ryckelynck JP, Fabre E, Evans D. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol. 2012;7:612-618.
15