Utilization and outcome of 'out-of-center hemodialysis' in the United States: a contemporary analysis.
Utilization and outcome of 'out-of-center hemodialysis' in the United States: a contemporary analysis.
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美国“中心外血液透析”的利用和结果：当代分析。
DOI：
10.1159/000314663
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Gill,JohnS
中科院分区：
文献类型：
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作者：
MacRae,JenniferM;Rose,CarenL;Jaber,BertrandL;Gill,JohnS
背景：有越来越多的兴趣在交付外的中心血液透析（HD），特别是在家庭环境中，但很少有系统的信息，其使用和结果在当代事件patients.Patients和方法：外的中心HD被定义为HD交付在住宅环境中，主要是在家里或在一个长期的护理设施（如疗养院），无论治疗的长度和频率。一项观察性队列研究确定了全因死亡率，该研究对458，329名在美国开始透析的成年患者进行了观察，医疗保险是主要支付者。结果：1995年至2004年间，中心外HD是1，641名（0.4%）合格参与者的首选方式，尽管存在显着的地理差异。与开始中心内HD或腹膜透析（PD）的患者相比，开始中心外HD的患者更年轻，更可能是非白人，合并症更少，中位收入更高，更可能就业。在多变量分析中，中心外HD患者的总体死亡风险高于中心内HD或PD患者（HR = 1.10，95% CI 1.04，1.17），尽管年轻和健康患者的相对死亡风险较低结论：在美国，中心外HD与开始透析的非透析患者的生存优势无关。这些结果要求在国家登记系统中更好地描述中心外HD，主要是为了有效地比较家庭HD与标准治疗的使用、结局和潜在受益。
Background:There is increasing interest in the delivery of out-of-center hemodialysis (HD), particularly in the home setting, but little systematic information about its use and outcome in contemporary incident patients is available.Patients and Methods:Out-of-center HD was defined as HD delivered in a residential setting, mainly at home or in a long-term care facility (such as a nursing home) irrespective of the length and frequency of therapy. All-cause mortality was determined in an observational cohort study of 458,329 adult patients initiating dialysis in the United States with Medicare as a primary payer.Results:Between 1995 and 2004, out-of-center HD was the initial modality in 1,641 (0.4%) of eligible participants, although there was significant geographic variation. Patients initiating out-of-center HD were younger, more likely to be nonwhite, had fewer comorbidities, a higher median income, and were more likely to be employed than patients initiating in-center HD or peritoneal dialysis (PD). In multivariate analysis, out-of-center HD patients had a higher overall risk of death compared to in-center HD or PD patients (HR = 1.10, 95% CI 1.04, 1.17), although the relative risk of death was lower in younger and healthier patients (HR = 0.78; 95% CI 0.61, 1.00).Conclusion:Out-of-center HD is not associated with a survival advantage among unselected patients initiating dialysis in the United States. These results call for better characterization of out-of-center HD in national registries, primarily to effectively compare the use, outcomes and potential benefits of home HD to standard therapies.