Elsevier

Kidney International

Volume 56, Issue 6, December 1999, Pages 2269-2275
Kidney International

Dialysis – Transplantation
Twenty-five years of experience with out-center hemodialysis

https://doi.org/10.1046/j.1523-1755.1999.00771.xGet rights and content
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Twenty-five years of experience with out-center hemodialysis.

Background

Out-center hemodialysis (HD) offers patients a better quality of life, a greater independence, and a better rehabilitation opportunity. A lower mortality than with other modalities of dialysis has been reported. In addition, in France the charges paid depend on the modality of dialysis, out-center HD being the less expensive, and savings are also accomplished through fewer patient transports, which are additionally reimbursed. We present a 25-year experience of out-center HD.

Methods

We retrospectively studied the clinical records of 471 patients treated between 1974 and 1997 in a single nonprofit organization operating regional home HD (H-HD) and facilities for self-care HD (SC-HD). Survival results were analyzed according to: (a) causes of end-stage renal disease, (b) age at the start of HD, (c) period of start of HD, (d) modality of HD (H-HD, SC-HD), and (e) a subgroup of 174 patients defined at risk because they were contraindicated for transplantation.

Results

The mean age at the start of HD increased from 31.2 ± 9.7 (mean ± SD) years in 1974 to 52.6 ± 13.5 years in 1997. Causes of the end of treatment were: (a) transplantation (63%), (b) transfer (20%), and (c) death (17%). The overall survival was 90% at 5 years, 77% at 10 years, 62% at 15 years, and 45% at 20 years, and, for the group at risk, 78%, 62%, 46%, and 31%, respectively. Cox proportional hazard analyses showed that risk factors were older age, diabetes, and renal vascular diseases.

Conclusion

If adequate choice is given, out-center HD offers a reliable and safe modality of dialysis with better survival results than survival in full-care in-center HD. In addition, out-center HD ensures a striking financial benefit as compared with the higher costs if the same patients were treated with full-care in-center HD. These modalities should be encouraged for all HD patients who are able to be treated by out-center modalities.

Keywords

dialysis modalities
home hemodialysis
self-care hemodialysis
end-stage renal disease
renal replacement therapy

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