Risk of Major Adverse Cardiovascular Events in Home Dialysis Compared With In-Center Hemodialysis - clinical research

Sep 28, 2026

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Cardiovascular events are the leading cause of death among dialysis patients, yet differences in event frequency and type across dialysis modalities remain unclear. This study compares the risk of major adverse cardiovascular events (MACE) among continuous ambulatory peritoneal dialysis, automated peritoneal dialysis, home hemodialysis, and in-center hemodialysis. Data from 968 Finnish patients entering dialysis between 2004 and 2017 were analyzed using cumulative incidence and Cox regression with confounder adjustment.

LanguageEnglish

CategoryHealthcare

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Background

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Introduction

Clinical Research Risk of Major Adverse Cardiovascular Events in Home Dialysis Compared With In-Center Hemodialysis Wisam Bitar , 1 Jaakko Helve, 1,2 Mikko Haapio, 1 Virpi Rauta , 1,3 Eero Honkanen, 1 and Patrik Finne 1,2 Key Points c We observed a comparable cumulative incidence of major adverse cardiovascular event (MACE) in in-center hemodialysis (IC-HD) and continuous ambulatory peritoneal dialysis (PD) patients, which was higher than in automated PD and home hemodialysis patients. c After adjustment for confounders, there was no difference in risk of MACE between patients on home dialysis modalities and IC-HD. c Compared with IC-HD, PD was associated with lower risk of MACE among female patients and higher risk among male patients. Abstract Background Among dialysis patients, cardiovascular events are the leading cause of death. Little is known about how the frequency and type of cardiovascular events differ between various dialysis modalities. We compared risk of major adverse cardiovascular events (MACEs) in patients who started continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), and home hemodialysis with in-center hemodialysis (IC-HD) patients. Methods We included 968 patients who entered dialysis in the Helsinki-Uusimaa health care district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home hemodialysis, and 432 on IC-HD at day 90 from the start of dialysis. MACE was deﬁned as acute myocardial infarction, stroke, or death due to cardiovascular disease. The cumulative incidence of the ﬁrst MACE was calculated. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for potential confounding factors. Results Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6%) during the ﬁrst year of follow-up. The cumulative incidence of ﬁrst MACE was similar in IC-HD and CAPD patients and higher than that in APD and home hemodialysis patients. After adjustment for possible confounders, the hazard ratio (HR) of MACE was 1.22 (95% conﬁdence intervals [CIs], 0.73 to 2.05) for CAPD, 0.86 (95% CI, 0.47 to 1.57) for APD and 0.67 (95% CI, 0.30 to 1.50) for home hemodialysis compared with IC-HD. Unexpectedly, compared with IC-HD, peritoneal dialysis associated with lower risk of MACE among female patients (HR, 0.37; 95% CI, 0.14 to 0.99) and higher risk among male patients (HR, 1.80; 95% CI, 1.11 to 2.92) . Conclusions In this cohort, the risk of MACE was comparable across in-center and home dialysis modalities. However, the result differed between male patients and female patients, which requires further research. CJASN 20: 81–87, 2025. doi: [https://doi.org/10.2215/CJN.0000000579](https://doi.org/10.2215/CJN.0000000579) This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Cardiovascular disease is the most common cause of death among dialysis patients and causes approximately 40% of the deaths.1 Dialysis patients have been shown to have a 10-fold to 20-fold risk of dying from cardiovascular diseases compared with general population.2,3 1Nephrology Department, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 2Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland 3Strategy and Development, Helsinki and Uusimaa Hospitals District, Helsinki, Finland Correspondence: Dr. Wisam Bitar, email: wisam.bitar@hus.ﬁ Received: April 24, 2024 Accepted: November 14, 2024 Published Online Ahead of Print: November 19, 2024 See related Patient Voice, “Dialysis for Decades, Then My Heart Breaks: A Patient Perspective,” on pages 1–2 . Copyright © 2024 The Author(s) . Published by Wolters Kluwer Health, Inc. CJASN 20: 81–87, January,

FAQs

Which dialysis modalities were compared in this study?

The study compared continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), home hemodialysis, and in-center hemodialysis (IC-HD).

How was MACE defined?

MACE was defined as acute myocardial infarction, stroke, or death due to cardiovascular disease.

After adjusting for confounders, did home dialysis differ from in-center hemodialysis in MACE risk?

No. After adjustment, there was no difference in MACE risk between home dialysis modalities and IC-HD.

Sep 28, 2026

Uploaded by Himbo