65). The study reported the percentage of patients receiving treatment for 9 months or less: 85% of the HD group and 62% of the HHD group. A Canadian study enrolled 119 patients receiving HD, HHD, or PD.24 The duration of treatment was 44 months for the HD group and 38 months for the HHD group. No significant difference was noted between HD and HHD patients on the Self-Anchoring Striving Scale. On the Index of Well-Being and the Health State Utility/Time Trade-off, scores for HHD patients were significantly higher than HD patients. Change in Dialysis Modality (Appendix C, Table 1) One US registry study reported a significantly greater risk of changing dialysis modalities in the HHD patients compared to the HD patients (HR 10.4 [95% CI 8.9, 12.3]).8 Over the follow-up of up to 4 years, 26% of the HHD patients changed modality (97% to HD, 3% to PD) compared to 3% of the HD patients. The multi-national study reported that over a maximum follow-up of 4 years (median of 1.8 years), 14% of the HHD patients switched modalities (all to HD) compared to 0% of the HD patients.13 The study from the UK reported that median technique survival for HHD was 18 months (IQR 9 to 33 months).14 Of 130 patients with known reasons for stopping HHD, 30 (23%) switched to HD (hospital or satellite) and 1 (0.8%) to PD. The remaining patients either underwent kidney transplant (n=77) or died (n=22). The recent CCT from the US reported no significant difference in percentage of either HHD or HD patients who transferred to PD. 17 Transplantation (Appendix C, Table 1) A US registry study found no difference in the percentage of patients receiving a transplant (HHD 10.2%, HD 10.8%, HR 1.05 [95% CI 0.89, 1.25]). 8 The multinational study also reported no difference in transplantation between HHD and HD (9.5 and 8.8/100 person-years, respectively). 13 The maximum follow-up was 4 years in both studies; the multinational study reported a median follow-up of 1.8 years. Adverse Events (Appendix C, Table 4) The Canadian RCT, a 6 month study, found no difference in adverse events between HHD and HD. 15 Specifically, there were no significant differences in the number of patients with one or more cases of infection requiring a procedure or the number of patients with one or more vascular access surgical interventions. For adverse event reporting, the Canadian CCT combined 24 Home-based versus In-center Dialysis Evidence-based Synthesis Program data from the daily and nocturnal HHD groups.19 The annual rates of access complications and access interventions did not differ between the HHD groups and the HD group. Another CCT, from Italy, including 148 patients on either conventional HD (mostly in-center) or daily HD (70% at home), reported a significant difference in the rate of access closures (9.8 per 100 patient-years in the HD group, 2.2 per 100 patient-years in the HHD group; rate difference 7.6 [95% CI 3.4, 11.9], P < .01).25 There was also a significant difference in the 3-year probability of access survival (70% HD, 92% HHD; P < .05). Catheter-related events were reported in the recent CCT from the US. 17 Considering only the first catheter, there was no difference between groups in the rate of sepsis (16% HHD, 12% HD; P = .21) or time to sepsis (P = .98). Median catheter duration was 5.6 months in the HHD group and 4.6 months in the HD group (P = .64). KEY QUESTION 1A. What are the benefits and harms (ie, all-cause mortality, cardiovascular events, hospitalizations, depression, cognitive impairment, quality of life, conversion to a different type of dialysis, complications related to vascular access, complications of dialysis) of the various modalities of in-home hemodialysis (ie, short daily, nocturnal) compared to conventional hemodialysis? Different In-Home Modalities Compared to In-Center Hemodialysis Few studies included different HHD modalities. The registry study from Australia/New Zealand included patients receiving more frequent or extended (including nocturnal and short daily regimens) HD and HHD. 12 Over a follow-up period of up to 11 years and 9 months, there was reduced mortality with more frequent or extended HHD compared to HD (HR 0.53 [95% CI 0.41, 0.68]), a finding similar to the reduction in mortality with any HHD compared to HD. The percentages of deaths due to cardiovascular causes were 65% for the HHD group and 73% for the more frequent or extended HHD group.12 As noted above, in 3 other registry studies the HHD was longer and/or more frequent than the conventional HD. Two reported reduced mortality overall (maximum follow-up of 4 years) in the HHD group.8,13 In one study reporting cardiovascular mortality, there was no difference between HHD and HD. 8 A more recent study reported no difference in all-cause hospitalizations although, as noted above, there were differences between groups for different causes of hospitalization.20 In 4 of the RCTs and CCTs cited above, the HHD regimens were different in frequency and/or duration than the HD regimens.15-17,19 None of the studies reported a mortality difference between HHD and HD. Additionally, the recent CCT reported no differences between more frequent and extended HHD and conventional HD in catheter-related sepsis, median catheter life, or transfer to PD. 17 Another CCT