Data were retrospectively analysed from a cohort of New Zealanders in the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) Registry. Survival was compared over a 15-year period between those treated with home haemodialysis (HD; defined as dialysis in an independent fashion in an unstaffed setting using either HD or peritoneal dialysis [PD]) and those treated with facility HD (defined as dialysis in a dependent fashion at a staffed hospital or satellite dialysis HD unit), adjusting for measured patient risk factors such as age and co-morbidity. A total of 6419 adult patients with 3254 deaths were identified over 20,042 patient-years of follow-up with sufficient data for modelling. Patients treated with PD and facility HD had comparable demographics and co-morbidity. However, compared to those treated with PD or facility HD, patients on home HD were younger, more likely to have end-stage kidney disease (ESKD) secondary to single-organ (e.g. glomerulonephritis) rather than systemic disease, and less likely to have diabetes mellitus or medical co-morbidity. Compared to facility HD, home dialysis (as a unified category) was associated with an overall 13% lower mortality risk. In a second set of analyses that compared facility HD with PD and home HD separately, there was no difference in mortality risk between PD and facility HD, although PD was associated with a 20% lower mortality risk in the early period (<3 years) that was offset by a 33% greater mortality risk in the late period (>3 years), with no overall net effect. Overall, there was a 52% lower mortality risk associated with home HD, with no significant variation of the presence and extent of this effect over time. Effect modification and less observable benefit was associated with PD in those with diabetes mellitus, co-morbidity, and in New Zealand Māori and Pacific people. There was no effect modification by age or by era.
