Original InvestigationDialysisAdverse Technical Events in Home Hemodialysis
Section snippets
Study Population
The cohort consisted of all consecutive adult patients who initiated and completed HHD training at the University Health Network, Toronto General Hospital HHD training facility (Toronto, Ontario, Canada) from January 1, 1999, through December 31, 2011, with a date of last follow-up of July 1, 2012. We included patients who were receiving conventional HHD (3-5 hours, 3 treatments per week), intensive HHD (defined as an initial HHD prescription of ≥ 16 hours per week), and short daily hemodialysis
Cohort
The cohort consisted of 202 HHD patients. Characteristics of the complete cohort and patients with or without an event are shown in Table 1. Most (79%) events occurred among patients with an arteriovenous fistula. The other patient characteristics at the start of HHD training were similar.
Events
There were 22 first events and 7 recurrent events (total follow-up of 757 patient-years and 183,603 dialysis treatments). Characteristics of events are noted in Table 2. Four patients with an event (18%) were
Discussion
In this study of HHD patients, we identified that the overall rate of adverse technical events is low. Furthermore, when we considered only severe events (those requiring intervention), an even lower rate was appreciated. Appropriate identification and attempts at retraining were made in all patients after adverse events; however, even in those who were retrained, events recurred.
This study provides further evidence that catastrophic events (including those that are not severe and do not
Acknowledgements
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Contributions: Research idea and study design: KKT, CD’G, RF, SF, EW, CTC; data acquisition: KKT, CD’G, RF, SF, EW, CTC; data analysis/interpretation: KKT, CTC; statistical analysis: KKT. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity
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