Q J Med 1999; 92: 251-260
© 1999 Association of Physicians
Long-hours home haemodialysis—the best renal replacement therapy method?
From the Renal Unit, Parhon Hospital, Iasi, Romania, 1 Renal Unit, Guy's Hospital, London, and 2 Renal Unit, Withington Hospital, Manchester, UK
Received 20 November 1998 and in revised form 18 February 1999
Dr A. Covic, Nephrology CWRU/MHMC, 2500 Metrohealth Drive, Rammelkamp R203, Cleveland, Ohio 44109-1998, USA e-mail: amc21{at}po.cwru.edu
Two hundred and eighty-six patients (190 males and 96 females) with end-stage renal failure (ESRD) started haemodialysis (HD) at Withington Hospital between 1 January 1968 and 31 December 1986. Of these, 152 (53.1%) were successfully transplanted, while 134 had only HD or one transplant lasting <3 months (i.e. total HD interruption <3 months). For the whole group, the probabilities of being alive on long-hours home HD at 10 and 20 years were 58.7% and 33.2%, respectively. Mean gross mortality 1968–1986 was 6.5±3.2% per year. The main causes of death were cardiovascular (36.6%), infection-related (19.2%) and malignancy (9.6%). Males and younger cohorts had a significantly (p<0.05) higher probability of being alive on long-hours home HD than did females and older cohorts. Eighty-two patients (29% of the total group) survived more than 10 years, of whom 54 were still alive at 1 January 1996: 44 continuing on HD while the other ten had been successfully transplanted. In these 54 patients, mean 24-h ambulatory blood pressure recorded at the date of the study was 117.6/68.9 mmHg; mean BP for the last 5 years on HD was 136.4/81.2 mmHg. Only four (7.4%) were regularly taking antihypertensive medication. Left ventricular hypertrophy (LVH) (by ECG) was present in 64.8% of the 54 patients; its prevalence by echocardiography (LVM index >130 g/m2 for men and >110 g/m2 for women) was 77.5%. Only 10 (18.5%) had symptoms or clinical signs of ischaemic heart disease and/or peripheral vascular disease. None had cardiac failure symptoms NYHA class 3–4. Our data show a low incidence of all-cause and cardiovascular mortality, confirming those from the Tassin unit in France, and make a medical case for extended haemodialysis treatment hours.
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