improvement in 8 domains of SF-36 compared to PD; only “physical functioning” and “general health” domains were significantly different from PD at 1 year b. HD patients showed significantly greater improvement in sleep domain of CHEQ; PD patients showed significantly greater improvement in finance domain -Adjusted ORs for improvement in health status (PD vs HD): SF-36 Physical Composite 0.79 (0.52, 1.20) SF-36 Mental Composite 0.95 (0.62, 1.45) CHEQ Global QOL 0.90 (0.56, 1.45) NR CHEQ = CHOICE Health Experience Questionnaire; KDQOL = Kidney Disease Quality of Life instrument; MCS = mental health component summary; N/A = not applicable; PCS = physical component summary 37 Home-based versus In-center Dialysis Evidence-based Synthesis Program Adverse Events (Appendix C, Table 4) A report from the NECOSAD cohort identified adverse events.71 Incidence rate ratios (HD vs PD) for the study period (maximum follow-up of 10 years) were 1.65 (95% CI 1.34, 2.03) for total infections, 4.10 (95% CI 3.06, 5.58) for dialysis technique-related infections, and 0.56 (95% CI 0.40, 0.79) for non-dialysis technique-related infections. A longitudinal study (mean followup 1.3 years) from Canada with 369 patients reported fewer access-related invasive interventions in the PD group than the HD group (1.0 vs 1.4 per patient-year; Rate Ratio 0.72 [95% CI 0.53, 0.96]).72 A US study with 181 patients found no difference between HD and PD in median total infections per time at risk or infection rate per year at risk. 56 There was a higher bacteremia/fungemia infection rate in the HD group and a higher peritonitis rate in the PD group (both P < .001). A longitudinal study (follow-up of up to 19 months) from the Netherlands reported pancreatitis in one HD patient (0.4%) and 7 PD patients (5.4%) (P < .001).73 A study from Belgium with a 10 year follow-up period reported reasons for switching dialysis modalities. 74 Among 35 patients who switched from HD to PD, cardiovascular problems were reported by 40%, access problems by 25%, and blood pressure problems by 12%. Among 32 patients who switched from PD to HD, peritonitis or exit-site infections were reported by 50%, adequacy and/or ultrafiltration problems by 25%, and extraperitoneal leakage of dialysis fluid by 11%. A cross-sectional study from the UK reported gastrointestinal symptoms. 75 Both HD and PD patients experienced a higher rate of symptoms compared to hospital outpatient controls and community controls with abdominal pain in 72% of HD patients and 65% of PD patients, laxative use in 43% of HD patients and 79% of PD patients, and irritable bowel syndrome in 21% of HD patients and 33% of PD patients. Peritoneal Dialysis Compared to In-Home Hemodialysis Two studies provided a comparison of PD and HHD. 9,14 One study was from the US9 and the other from England and Wales.14 Enrollment years and follow-up durations were similar ranging from 1995 to 2005 and 9 years, 3 months to 10 years, respectively. Sample sizes differed with the US study including 38,894 incident patients (1,641 out-of-center HD [mostly home])9 and the UK study including 1,125 incident patients (225 HHD). 14 In the US study, HHD patients were more likely non-white compared to PD patients9 while in the UK study, HHD patients were more likely white. 14 Both studies used Cox proportional hazards models with an intent-to-treat approach. The US study found no significant difference in mortality risk between the 2 modalities (HR 1.04 [95% CI 0.98, 1.11]) (Table 4 and Appendix C. Table 1).9 The UK study reported a significant survival benefit associated with HHD (HR 0.61 [95% CI 0.40, 0.93]).14 The benefit was observed after adjustment for patients from the HHD group being more likely wait-listed for kidney transplant. Neither of the studies reported interactions with age, gender, race, BMI, diabetes, cardiovascular disease, or duration of ESRD therapy, although the US study did note that the results did not differ among patients more likely to reside at home (based on age, ability to ambulate and transfer independently, and diabetes and/or cardiovascular disease) or more likely to reside in a long-term care facility. 9 38 Home-based versus In-center Dialysis Evidence-based Synthesis Program Table 4. Mortality – Home Hemodialysis (HHD) versus Peritoneal Dialysis (PD) – Registry Data Country/ Region: Number of Reports Study Years Patients: Number of Reports or Sample Size Overall Mortality: Number of Reports Number of Studies Reporting Effects by: No difference Favor PD Favor HHD Age Gender Race BMI DM CVD ESRD Duration REGISTRY STUDIES USA: 1 1995-2004 Incident: 1 1 UK: 1 1997-2005 Incident: 1 1 Other Outcomes Cardiovascular Events, Hospitalization, Quality of Life, Cognition, Depression, Transplantation Neither of the studies reported these outcomes for HHD compared to PD. Change in Dialysis Modality (Appendix C, Table 1) As noted above in the section describing studies comparing HHD to in-center HD, the study from the UK reported that median technique survival for HHD was 18 month (IQR 9 to 33 months).14 Most patients underwent a kidney transplant or switched to in-center HD. KEY QUESTION 2A. Do results differ depending on whether peritoneal dialysis was the initial therapy or the therapy used following failed incenter dialysis? A prospective