Thirty years of universal home dialysis in Christchurch

Aim. To review 30 years of universal home dialysis in a single dialysis uni t. Method. Analysis for patients using home dialysis since 1969 of information from hospital visits, clinical case notes and demographic and survival dat a from the Australia and New Zealand Dialysis and Transplant Registry. Results. Since 1969 treatment options at the Christchurch Nephrology Unit f or patients with end-stage renal disease have been home haemodialysis (HD), renal transplantation and, since 1979, continuous ambulatory peritoneal di alysis (CAPD). No long-term, hospital-based treatment has been offered. Dur ing this rime 493 patients, aged 3-82 years, began treatment. The mean trai ning time for home HD was 79 days (range 23-268) and for home CAPD 7 days ( range 1-35). The mean HD treatment time was 7 hours x 3 per week (range 10- 36 hours/week). Between 1980 and 1995, less than 5% of patients took antihy pertensive drugs and 73% of those aged 18-65 years were in full or part-tim e employment The mean age of patients commencing treatment increased from 4 1.8 years in the 1970s to 50.1 years in the 1990s. The median patient survi val from 1970- 1997 was 7.75 years on home HD and 2.1 years on home CAPD, M edian survival on dialysis fell. in the. 1990's as more diabetics and older patients with comorbidity started treatment, Conclusions. Home HD allows good rehabilitation, long treatment times and g oad blood pressure control which may all contribute to the superior surviva l of home versus hospital HD. CAPD survival in Christehurch was worse than HD, but this is probably due to patient selection. A policy of universal ho me dialysis is still workable provided there are sufficient resources for t raining and support of patients in the community.