Home dialysis as good as cadaver transplant

Home dialysis after kidney failure is as effectiveforpatient survival as receiving an organ transplant from a deceased donor, a new study suggests.

In the study conducted by Canadian researchers, a total of more than 1,200 patients were followed for up to 12 years.

The subjects came from three groups those who received kidney transplants froma deceased donor, those who received transplants from aliving donor and those receiving nighthemodialysis at home.

Night home hemodialysis is an intensive form of frequent and prolonged treatment done while the patient sleeps. Itlasts for six to eight hours a night for up to seven nights a week, compared withthe 12 hours of conventional dialysis typically done at a hospital or health-care facility.

Documented benefits of night home hemodialysis include improvement of blood pressure control and heart function, said Dr. Christopher Chan, one of the study's principal investigators.

Dialysis patients were from Toronto General Hospital and Humber River Regional Hospital, while information on transplant patients came from the United States Renal Data System database.

The three groups were matched to compare survival of those receiving dialysis and those who were recipients of kidneys from deceased and living donors.

Living donor survival best

According to findings published in the international September issue of Nephrology Dialysis Transplantation, researchers found survival for night home hemodialysis patients was comparable to that of patients who had received kidney transplants from deceased donors.

Survival among patients who received kidneys from living donors was better than both groups.

Since people on a donor transplant list will wait longer than those able to have a pre-emptive transplant, researchers wanted to ensure the comparisons between groups would be valid, Chan said. To that end, they matched the duration of wait time to the amount of time the patient had spent on standard dialysis before they converted to nightly hemodialysis.

Chan, medical director of home hemodialysis at Toronto General Hospital, said the study marks the first time they've be able to document the long-term survival of patients using this type of dialysis.

What's more, the therapy provides a "suitable alternative" for patients who may not be able to have a transplant, which can occur when there are too many complications or an immunological risk.

Body 'repeating the benefits' overnight

"I think our study will provide another option for patients who are looking towards improving their survival and also improving their outcomes," said Chan, who is also an associate professor of medicine at the University of Toronto.

Florence Tewogbade was slated to receive a kidney from a family member but as the surgery date approached, it turned out the match wasn't right. And receiving a donated kidney through a waiting list could take up to 10 years.

She has been on dialysis since 2004. But the 27-year-old said the thrice-weekly, four-hour visits for treatment left her too tired to do much else, including going to school.

Since starting night home hemodialysis last year, Tewogbade said her energy level has experienced a "complete 180."

"I could almost feel like what I was doing was really good for my body, and my body was really reaping the benefits of doing it overnight, versus doing it in-centre," she said.

"So the fact that this study now shows that doing nocturnal dialysis is as effective as a deceased donor [transplant] is very encouraging news for me."

Call foruser-friendly machines

Because of the technical complexity and some other barriers towards adopting home dialysis, Chan said the therapy may not be optimal for all who require the treatment. There may be some who view it as too complicated.

Chan said with technical changes and more user-friendly machines, access can be improved for patients wanting to try it.

The findings are exciting, said Dr. Michael Copland, a nephrologist at VancouverGeneral Hospital and provincial medical director for independent hemodialysis.

Nocturnal dialysis comprises between about five to seven per cent of B.C.'s total dialysis population, hesaid, addingconventional hemodialysis is also a life-supporting therapy.

The next step has to be looking towards how the information can be used to encourage people to consider night dialysis.