Characteristics, practices, and outcomes in a Belgian cohort of incident home hemodialysis patients: A 6‐year experience

Abstract

Background: Home hemodialysis (HHD) remains underused in patients with kidney failure. Current literature on HHD mostly originates from non-European countries, making generalization difficult. The present study describes patients' profile and practice patterns from a Belgian HHD center, and assesses patient and technique survival and complications associated with HHD.Methods: We analyzed data from all our incident patients during a 6-year period. The patient's characteristics were summarized using descriptive statistics. Transition to another therapeutic modality, estimated using a risk model with death and transplantation as competing events, episodes of respite cares and hospitalizations, and access complications were analyzed.Results: Eighty patients (mean age: 47 years; male: 64%) met the inclusion criteria. Fifty-one percent of patients initiated dialysis with a central venous catheter (CVC) and 96% were not assisted. Arterio-venous fistula (AVF) cannulation was performed using buttonhole technique. Standard-frequent HD (47%) and short-frequent low-flow dialysate HD (34%) were mostly used at HHD initiation. Cumulative incidences of technique failure and death were 15%, 24%, and 32% at 1, 2, and 5 years. Incidence rates for respite dialysis and hospitalizations were 2.39 and 0.54 per patient-year of HHD. In comparison with AVF, incidence rate ratios of overall access complications and accessrelated infections for CVC were 4.3 (95% CI: 3.1-6, p < 0.01) and 4.4 (95% CI: 2.1-10, p < 0.01), respectively. Buttonhole cannulation was complicated by 0.26 (95% CI: 0.15-0.46) infections per 1000 AVF-days. Conclusions:This present study provides important information about patient's profile and practice patterns and safety in a cohort of 80 incident Belgian HHD patients, with encouraging techniques and patient survival. K E Y W O R D S arterio-venous fistula, buttonhole cannulation, central venous catheter, home hemodialysis, technique failure, technique survival Bernard Vô and Blaise Anthonissen contributed equally to this work.

Friction injury of the central vein caused by catheter for hemodialysis: an in vitro study

“…Although the KDOQI Guideline for Vascular Access: 2019 Update still does not consider central venous catheters (CVCs) as the preferred vascular access for HD 2 , the real proportion is much higher, particularly in older patients and patients with diabetes, and > 60% of patients’ first HD access is CVC 3 , 4 . In addition, > 50% of the patients on home HD have a CVC as their initial vascular access 5 , 6 . Moreover, recent studies have found that CVCs are not directly associated with mortality 7 , 8 .…”