Survival at Home

An important measure of the impact of a medical treatment is its ability to prolong life. Numerous studies have examined the association between mortality rates and modality choice for dialysis. Compared to conventional in-center hemodialysis, the majority of data indicate that home hemodialysis (HHD) is associated with improved mortality. When comparing HHD to peritoneal dialysis (PD), HHD appears to confer similar to improved mortality compared to PD. Interestingly, some studies have found that intensive HHD is associated with similar mortality outcomes versus deceased donor kidney transplantation in select patients. An important limitation is that these studies are conducted retrospectively. Despite researchers’ best efforts, confounders such as selection bias and inability to fully account for non-dialytic factors affecting mortality cannot be fully controlled for.