Home dialysis as effective as hospital dialysis for patients with kidney transplant failure

St. Michael's HospitalJan 14 2011

Survival rates similar for home and hospital dialysis, but few choose home version despite flexibility, cost savings

Patients who must return to dialysis after a kidney transplant failure survive just as well on home dialysis as hospital dialysis, but few choose that option, according to new research by Dr. Jeffrey Perl, a nephrologist at St. Michael's Hospital.

Despite medical advances, transplanted kidneys don't last a lifetime and an increasing number of patients return to dialysis. These patients are at higher risk for complications and death than other dialysis patients because of such things as their exposure to immunosuppressive drugs and the length of time they were on dialysis,

According to a study in an upcoming issue of the Clinical Journal of the American Society Nephrology, only 18 per cent of these patients choose home dialysis. Yet the study showed no higher death rate among them and those who did dialysis in the hospital at two years, after two years and overall. The study tracked 2,110 Canadian adult patients over 14 years between 1991 and 2005.

Home dialysis, known as peritoneal dialysis, allows patients to manage their own therapy and live a relatively flexible lifestyle, including travel. Cleansing fluids are pumped into a patient's abdomen through a catheter tube. The fluid removes toxins and water from the blood using the peritoneum, the membrane lining the abdomen, as a filter. Waste products are drained several times a day. In hemodialysis, conducted in a hospital, blood is removed from the body, filtered and then returned.

Even though the number of people requiring dialysis is rising, home dialysis is declining in both Canada and the United States. Dr. Perl said one reason may be that patients whose transplants have failed may be reluctant to restart dialysis. The focus of their care may be trying to salvage the transplant, with less emphasis on education about and preparation for other options.

"It is important to empower patients who have kidney transplant failure to realize that despite the severe disappointment of returning to dialysis, they still have many options for dialysis therapy, which include opportunities for home-based therapies," Dr. Perl said.

Home-based dialysis is significantly less expensive than hospital dialysis.