Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation

M. Molnár, Vanessa Ravel, Elani Streja, Csaba P. Kovesdy, Matthew B. Rivara, Rajnish Mehrotra, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: To compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx). Design: Prospective cohort. Setting: Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. Participants: Using data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event. Measurements: Modality of renal replacement therapy. Results: The baseline mean age ± standard deviation of the PS-matched individuals undergoing home HD was 71 ± 6, and that of KTx recipients was 71 ± 5, 69% of both groups were male, 81% of those undergoing home HD and 79% of KTx recipients were white, and 11% and 12%, respectively, were African American. Median follow-up time was 205 days (interquartile range (IQR) 78–364 days) for those undergoing home HD and 795 days (IQR 366–1,221 days) for KTx recipients. There were 97 deaths (20%, 253/1,000 patient-years, 95% confidence interval (CI) = 207–309/1,000 patient-years) in the home HD group and 48 deaths (10%, 45/1,000 patient-years, 95% CI = 34–60/1,000 patient-years) in the KTx group. Elderly adults undergoing home HD had a risk of mortality that was almost five times as high as that of KTx recipients (hazard ratio = 4.74, 95% CI = 3.25–6.91). Similar results were seen in competing risk regression analyses (subhazard ratio = 4.71, 95% CI = 3.27–6.79). Results were consistent across different types of kidney donors and subgroups divided according to various recipient characteristics. Conclusion: Elderly adults with ESRD who receive a KTx have greater survival than those who undergo home HD. Further studies are needed to assess whether KTx receipt is associated with other benefits such as better quality of life and lower hospitalization rates.

Original languageEnglish
Pages (from-to)2003-2010
Number of pages8
JournalJournal of the American Geriatrics Society
Volume64
Issue number10
DOIs
Publication statusPublished - Oct 1 2016

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Home Hemodialysis
Kidney Transplantation
Survival
Confidence Intervals
Propensity Score
Kidney
Chronic Kidney Failure
Mortality
Renal Replacement Therapy
Electronic Health Records
Information Systems
African Americans
Dialysis
Hospitalization
Regression Analysis
Quality of Life
Tissue Donors
Transplants

Keywords

  • elderly
  • home hemodialysis
  • kidney transplantation
  • mortality
  • survival

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Molnár, M., Ravel, V., Streja, E., Kovesdy, C. P., Rivara, M. B., Mehrotra, R., & Kalantar-Zadeh, K. (2016). Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation. Journal of the American Geriatrics Society, 64(10), 2003-2010. https://doi.org/10.1111/jgs.14321

Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation. / Molnár, M.; Ravel, Vanessa; Streja, Elani; Kovesdy, Csaba P.; Rivara, Matthew B.; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar.

In: Journal of the American Geriatrics Society, Vol. 64, No. 10, 01.10.2016, p. 2003-2010.

Research output: Contribution to journalArticle

Molnár, M, Ravel, V, Streja, E, Kovesdy, CP, Rivara, MB, Mehrotra, R & Kalantar-Zadeh, K 2016, 'Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation', Journal of the American Geriatrics Society, vol. 64, no. 10, pp. 2003-2010. https://doi.org/10.1111/jgs.14321
Molnár, M. ; Ravel, Vanessa ; Streja, Elani ; Kovesdy, Csaba P. ; Rivara, Matthew B. ; Mehrotra, Rajnish ; Kalantar-Zadeh, Kamyar. / Survival of Elderly Adults Undergoing Incident Home Hemodialysis and Kidney Transplantation. In: Journal of the American Geriatrics Society. 2016 ; Vol. 64, No. 10. pp. 2003-2010.
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N2 - Objectives: To compare the mortality of elderly adults with end-stage renal disease (ESRD) treated with home hemodialysis (HD) with that of those receiving a kidney transplant (KTx). Design: Prospective cohort. Setting: Pertinent data for the two groups were obtained from electronic medical records from a large dialysis provider and the U.S. Renal Data System. Participants: Using data from elderly adults (aged ≥65) who started home HD and underwent KTx in the US between 2007 and 2011, a 1:1 propensity score (PS)-matched cohort of 960 elderly adults was created, and the association between treatment modality and all-cause mortality was examined using Cox proportional hazards and competing risk regression survival models using modality failure as a competing event. Measurements: Modality of renal replacement therapy. Results: The baseline mean age ± standard deviation of the PS-matched individuals undergoing home HD was 71 ± 6, and that of KTx recipients was 71 ± 5, 69% of both groups were male, 81% of those undergoing home HD and 79% of KTx recipients were white, and 11% and 12%, respectively, were African American. Median follow-up time was 205 days (interquartile range (IQR) 78–364 days) for those undergoing home HD and 795 days (IQR 366–1,221 days) for KTx recipients. There were 97 deaths (20%, 253/1,000 patient-years, 95% confidence interval (CI) = 207–309/1,000 patient-years) in the home HD group and 48 deaths (10%, 45/1,000 patient-years, 95% CI = 34–60/1,000 patient-years) in the KTx group. Elderly adults undergoing home HD had a risk of mortality that was almost five times as high as that of KTx recipients (hazard ratio = 4.74, 95% CI = 3.25–6.91). Similar results were seen in competing risk regression analyses (subhazard ratio = 4.71, 95% CI = 3.27–6.79). Results were consistent across different types of kidney donors and subgroups divided according to various recipient characteristics. Conclusion: Elderly adults with ESRD who receive a KTx have greater survival than those who undergo home HD. Further studies are needed to assess whether KTx receipt is associated with other benefits such as better quality of life and lower hospitalization rates.

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