Outcomes of integrated home dialysis care: a multi-centre, multi-national registry study
Bibliographic record
Abstract
BACKGROUND: The 'integrated home dialysis' model involving initiation of peritoneal dialysis (PD) first followed by home haemodialysis (HHD) has previously been proposed as an optimal form of dialysis that maximizes the advantages of both modalities. While this model has great potential, its clinical outcomes, especially compared with direct HHD initiation, remain uncertain. METHODS: All incident home dialysis patients from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry between 2000 and 2012 were included. Propensity score matching was performed to evaluate patients initially treated with PD followed by HHD ('PD + HHD'), PD without subsequent transition to HHD ('PD only') and HHD without subsequent transition to PD ('HHD only'). The composite primary outcome was death and home dialysis technique failure (defined as transfer to facility haemodialysis for 90 days). Groups were compared using a Cox proportional hazards model. RESULTS: The 2:1 matched cohort included 84 patients in the 'PD + HHD' group, 168 patients in the 'HHD only' group and 168 patients in the 'PD only' group. Compared with the 'PD + HHD' group, death and home dialysis technique failure was similar for patients treated with 'HHD only' [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.52-1.62; P = 0.77] and higher for those treated with 'PD only' (HR 3.22, 95% CI 1.97-5.25; P < 0.001). CONCLUSION: Patients treated with PD first followed by HHD had a risk of death and home dialysis technique failure that was comparable to those treated with HHD as the only home dialysis modality and inferior to those treated with PD as the only home dialysis modality. These results support the 'integrated home dialysis model' in patients who initiate dialysis with PD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".