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Rangaswamy D, Guddattu V, Webster AC, Borlace M, Boudville N, Clayton P, Badve S, Johnson DW, Sud K. Icodextrin use for peritoneal dialysis in Australia: A cohort study using Australia and New Zealand Dialysis and Transplant Registry. Perit Dial Int 2020; 40:209-219. [PMID: 32063201 DOI: 10.1177/0896860819894058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Icodextrin is a high molecular weight, starch-derived glucose polymer that is used as an osmotic agent in peritoneal dialysis (PD) to promote ultrafiltration. There has been wide variation in its use across Australia and the rest of the world, but it is unclear whether these differences are due to patient- or centre-related factors. METHODS Using the Australia and New Zealand Dialysis and Transplant Registry, all adult patients (>18 years) who started PD in Australia between 1 January 2007 and 31 December 2014 were included. The primary outcome was icodextrin use at PD commencement. Hierarchical logistic regression clustered around the treatment centre was applied to determine the patient- and centre-related characteristics associated with icodextrin use. The impact of centre-level practice pattern variability on icodextrin uptake was estimated using the intra-cluster correlation coefficient (ICC). RESULTS Of 5948 patients starting on PD in 58 centres during the study period, 2002 (33.7%) received icodextrin from the outset. Overall uptake of icodextrin increased from 29% in 2010 to 42.5% in 2014. Patient-level characteristics associated with an increased likelihood of commencing PD with icodextrin included male sex (adjusted odds ratio (OR) 1.55, 95% confidence interval (CI) 1.35-1.77; p < 0.001), prior haemodialysis or kidney transplantation (OR 1.26, 95% CI 1.09-1.47), obesity (OR 1.66, 95% CI 1.41-1.96), diabetes mellitus (OR 2.32, 95% CI 2.03-2.64) and residing in a postcode with the highest decile of socio-economic status (OR 1.43, 95% CI 1.11-1.85). The centre-level characteristic associated with an increased likelihood of commencing PD with icodextrin was routine assessment of a peritoneal equilibration test (OR 1.45, 95% CI 1.27-1.66). Centres with fewer patients on automated peritoneal dialysis (APD) were less likely to start on icodextrin (APD proportion <57%; OR 0.45, 95% CI 0.20-0.99). Centre factors accounted for 25% of the variation in icodextrin use solution among incident PD patients (ICC 0.25). CONCLUSIONS Icodextrin use in incident Australian PD patients is increasing variable and associated with both patient and centre characteristics. Centre-related factors explained 25% of variability in icodextrin use.
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Affiliation(s)
- Dharshan Rangaswamy
- Department of Nephrology, Kasturba Hospital and Medical College, Manipal Academy of Higher Education, Manipal, Udupi, India
| | - Vasudeva Guddattu
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, India
| | - Angela C Webster
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Australia
| | - Philip Clayton
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Sunil Badve
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Department of Nephrology, St George Hospital, Sydney, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia.,Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia.,The University of Sydney Medical School, Sydney, Australia
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Li X, Xu H, Chen N, Ni Z, Chen M, Chen L, Dong J, Fang W, Yu Y, Yang X, Chen J, Yu X, Yao Q, Sloand JA, Marshall MR. The Effect of Automated versus Continuous Ambulatory Peritoneal Dialysis on Mortality Risk in China. Perit Dial Int 2018; 38:S25-S35. [PMID: 30315042 DOI: 10.3747/pdi.2017.00235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/15/2018] [Indexed: 12/12/2022] Open
Abstract
Background There is an emerging practice pattern of automated peritoneal dialysis (APD) in China. We report on outcomes compared to continuous ambulatory peritoneal dialysis (CAPD) in a Chinese cohort. Methods Data were sourced from the Baxter Healthcare (China) Investment Co. Ltd Patient Support Program database, comprising an inception cohort commencing PD between 1 January 2005 and 13 August 2015. We used time-dependent cause-specific Cox proportional hazards and Fine-Gray competing risks (kidney transplantation, change to hemodialysis) models to estimate relative mortality risk between APD and CAPD. We adjusted or matched for age, gender, employment, insurance, primary renal disease, size of PD program, and year of dialysis inception. We used cluster robust regression to account for center effect. Results We modeled 100,351 subjects from 1,178 centers over 240,803 patient-years. Of these, 368 received APD at some time. Compared with patients on CAPD, those on APD were significantly younger, more likely to be male, employed, self-paying, and from larger programs. Overall, APD was associated with a hazard ratio (HR) for death of 0.79 (95% confidence interval [CI] 0.64 – 0.97) compared with CAPD in Cox proportional hazards models, and 0.76 (0.62 – 0.95) in Fine-Gray competing risks regression models. There was prominent effect modification by follow-up time: benefit was observed only up to 4 years follow-up, after which risk of death was similar. Conclusion Automated peritoneal dialysis is associated with an overall lower adjusted risk of death compared with CAPD in China. Analyses are limited by the likelihood of important selection bias arising from group imbalance, and residual confounding from unavailability of important clinical covariates such as comorbidity and Kt/V.
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Affiliation(s)
- Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, the Medical School affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhaohui Ni
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Menghua Chen
- Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, PR China
- Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China, Beijing, PR China
| | - Wei Fang
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Yusheng Yu
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xueqing Yu
- Institute of Nephrology, Guangdong Medical University, Dongguan, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | - Mark R. Marshall
- Baxter Healthcare (Asia) Pte Ltd, Singapore
- and Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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