Kidney transplantation found superior to intensive home hemodialysis

Many studies have shown that kidney failure patients can receive many benefits from home hemodialysis that is done more often and for a longer stretch of time than is typically done in dialysis centers. While research indicates that conventional in-center hemodialysis is not as beneficial as kidney transplantation, it's unclear how intensive home hemodialysis compares with transplantation.

Karthik Tennankore, MD, FRCPC (Dalhousie University), Christopher Chan, MD, FRCPC (University of Toronto) and their colleagues conducted a study to compare long and frequent home hemodialysis (at least 16 hours/week) with kidney transplantation. Their study included 173 home hemodialysis patients and 1,517 transplant recipients (673 living donor, 642 standard criteria donor, and 202 expanded criteria donor recipients) who received care between 2000 and 2011 in a Canadian medical center.

Among the major findings:

• Kidney transplant patients had a 55% to 61% (depending on organ donor type) reduced risk of treatment failure or death during the study compared with patients on long and frequent home hemodialysis.
• The risk of being admitted to the hospital and spending a longer time in the hospital was higher for some kidney transplant patients up to a year after transplantation, but lower in the long term compared with dialysis patients.

"This study tells us that we should continue to promote kidney transplantation to eligible patients receiving longer, more frequent home hemodialysis even if they are doing well on their dialysis treatment," said Dr. Tennankore. "This study also tells us that patients who are receiving this type of dialysis still have very good health outcomes," he added.

In an accompanying editorial, Thomas Golper, MD and Rachel Fissell, MD (Vanderbilt University Medical Center) lauded the investigators for the rigorousness of their study. "The gap in clinical outcomes between all forms of kidney transplantation and the putative best forms of dialysis is large. This gap is made even more evident in the report by Tennankore et al," they wrote. They explained that transplantation is the most desirable and preferred form of kidney replacement therapy, but dialysis will continue to be important due to the scarcity of organs and the ineligibility of some patients for transplantation. New technologies will hopefully improve dialysis so that it provides more benefits in the future.