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van der Linde M, Salet N, van Leeuwen N, Lingsma HF, Eijkenaar F. Between-hospital variation in indicators of quality of care: a systematic review. BMJ Qual Saf 2024; 33:443-455. [PMID: 38395610 DOI: 10.1136/bmjqs-2023-016726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/17/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Efforts to mitigate unwarranted variation in the quality of care require insight into the 'level' (eg, patient, physician, ward, hospital) at which observed variation exists. This systematic literature review aims to synthesise the results of studies that quantify the extent to which hospitals contribute to variation in quality indicator scores. METHODS Embase, Medline, Web of Science, Cochrane and Google Scholar were systematically searched from 2010 to November 2023. We included studies that reported a measure of between-hospital variation in quality indicator scores relative to total variation, typically expressed as a variance partition coefficient (VPC). The results were analysed by disease category and quality indicator type. RESULTS In total, 8373 studies were reviewed, of which 44 met the inclusion criteria. Casemix adjusted variation was studied for multiple disease categories using 144 indicators, divided over 5 types: intermediate clinical outcomes (n=81), final clinical outcomes (n=35), processes (n=10), patient-reported experiences (n=15) and patient-reported outcomes (n=3). In addition to an analysis of between-hospital variation, eight studies also reported physician-level variation (n=54 estimates). In general, variation that could be attributed to hospitals was limited (median VPC=3%, IQR=1%-9%). Between-hospital variation was highest for process indicators (17.4%, 10.8%-33.5%) and lowest for final clinical outcomes (1.4%, 0.6%-4.2%) and patient-reported outcomes (1.0%, 0.9%-1.5%). No clear pattern could be identified in the degree of between-hospital variation by disease category. Furthermore, the studies exhibited limited attention to the reliability of observed differences in indicator scores. CONCLUSION Hospital-level variation in quality indicator scores is generally small relative to residual variation. However, meaningful variation between hospitals does exist for multiple indicators, especially for care processes which can be directly influenced by hospital policy. Quality improvement strategies are likely to generate more impact if preceded by level-specific and indicator-specific analyses of variation, and when absolute variation is also considered. PROSPERO REGISTRATION NUMBER CRD42022315850.
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Affiliation(s)
| | - Nèwel Salet
- Erasmus Universiteit Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | | | - Hester F Lingsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Frank Eijkenaar
- Erasmus Universiteit Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
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Nel H, Debbie F, Narelle H, Sean R, Aron C. A retrospective clinical and economic analysis of an assisted automated peritoneal dialysis programme in Western Australia . Perit Dial Int 2024; 44:203-210. [PMID: 37635394 DOI: 10.1177/08968608231190772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Assisted peritoneal dialysis (aPD) represents an alternative kidney replacement therapy for dialysis-dependent patients whose only other options are prolonged hospitalisations or transfer to in-centre haemodialysis (HD). Most programmes have not examined the role of temporary aPD, and there is limited data surrounding the economic implications of temporary aPD programmes. The main aim of this study was to describe the cost-effectiveness of an assisted automated peritoneal dialysis (aAPD) programme, for patients whose only reason to stay in hospital was the temporary inability to independently perform PD at home. METHODS Retrospective, single-centre analysis of 45 referrals for aAPD from November 2015 to May 2021. Two groups of patients were enrolled in the study: respite patients already established on PD (to facilitate discharge or prevent admission) and new patients who were not yet trained (to facilitate discharge). To calculate the cost differential, patients were allocated to either staying in hospital or transferring to centre-based HD with comparison to costs on aAPD. Costs were calculated using a healthcare system perspective over the duration of aAPD assistance. Clinical outcomes including peritonitis rate, hospitalisation and mortality were also assessed. RESULTS Overall, 1349 episodes of aAPD care were delivered. One thousand forty-two episodes (77%) were for respite patients and 307 episodes (23%) were for new patients awaiting training. The mean duration of assistance was 18 days for pretraining patients and 37 days for respite patients. Overall, the mean length of stay on the programme was 30 days with a range of 1-263 days (SD 43) and 73% of patients graduated to self-care PD. The cost of the aAPD programme was $242 per visit, with an average cost $7260 per patient-episode. The aAPD programme was significantly cheaper than the alternatives, with average hospitalization costs $46,170 per episode, and in-centre HD costs of $9667. $1.497 million was saved over the course of the study. Eleven hospitalisations occurred and the peritonitis rate was 0.8 episodes per patient-year. Two patients died while on aAPD. CONCLUSION This study provides the first detailed description of an aAPD respite programme in Australia. We conclude that the implementation of a temporary aAPD programme could lead to a significant reduction in healthcare costs, however peritonitis rates were high.
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Affiliation(s)
- Henco Nel
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Fortnum Debbie
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Hawkins Narelle
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Randall Sean
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Chakera Aron
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Fotheringham J, Solis-Trapala I, Briggs V, Lambie M, McCullough K, Dunn L, Rawdin A, Hill H, Wailloo A, Davies S, Wilkie M. Catheter Event Rates in Medical Compared to Surgical Peritoneal Dialysis Catheter Insertion. Kidney Int Rep 2023; 8:2635-2645. [PMID: 38106573 PMCID: PMC10719604 DOI: 10.1016/j.ekir.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction How patient, center, and insertion technique factors interact needs to be understood when designing peritoneal dialysis (PD) catheter insertion pathways. Methods We undertook a prospective cohort study in 44 UK centers enrolling participants planned for first catheter insertion. Sequences of regressions were used to describe the associations linking patient and dialysis unit-level characteristics with catheter insertion technique and their impact on the occurrence of catheter-related events in the first year (catheter-related infection, hospitalization, and removal). Factors associated with catheter events were incorporated into a multistate model comparing the rates of catheter events between medical and surgical insertion alongside treatment modality transitions and mortality. Results Of 784 first catheter insertions, 466 (59%) had a catheter event in the first year and 61.2% of transitions onto hemodialysis (HD) were immediately preceded by a catheter event. Catheter malfunction was less but infection was more common with surgical compared with medical insertions. Participants at centers with fewer late presenters and more new dialysis patients starting PD, had a lower probability of a catheter event. Adjusting for these factors, the hazard ratio for a catheter event following insertion (medical vs. surgical) was 0.70 (95% confidence interval [CI] 0.43 to 1.13), and once established on PD 0.77 (0.62 to 0.96). Conclusion Offering both medical and surgical techniques is associated with lower catheter event rates and keeps people on PD for longer.
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Affiliation(s)
- James Fotheringham
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ivonne Solis-Trapala
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Victoria Briggs
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Mark Lambie
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Keith McCullough
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Andrew Rawdin
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Harry Hill
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Allan Wailloo
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Davies
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Sakurada T, Kojima S, Yamada S, Koitabashi K, Taki Y, Matsui K, Murasawa M, Kawarazaki H, Shimizu S, Kobayashi H, Asai T, Hashimoto K, Hoshino T, Sugitani S, Maoka T, Nagase A, Sato H, Fukuoka K, Sofue T, Koibuchi K, Nagayama K, Washida N, Koide S, Okamoto T, Ishii D, Furukata S, Uchiyama K, Takahashi S, Nishizawa Y, Naito S, Toda N, Naganuma T, Kikuchi H, Suzuki T, Komukai D, Kimura T, Io H, Yoshikawa K, Naganuma T, Morishita M, Oshikawa J, Tamagaki K, Fujisawa H, Ueda A, Kanaoka T, Nakamura H, Yanagi M, Udagawa T, Yoneda T, Sakai M, Gunji M, Osaki S, Saito H, Yoshioka Y, Kaneshiro N. A multi-institutional, observational study of outcomes after catheter placement for peritoneal dialysis in Japan. Perit Dial Int 2023; 43:457-466. [PMID: 37632293 DOI: 10.1177/08968608231193240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This multi-institutional, observational study examined whether the outcomes after peritoneal dialysis (PD) catheter placement in Japan meet the audit criteria of the International Society for Peritoneal Dialysis (ISPD) guideline and identified factors affecting technique survival and perioperative complications. METHODS Adult patients who underwent first PD catheter placement for end-stage kidney disease between April 2019 and March 2021 were followed until PD withdrawal, kidney transplantation, transfer to other facilities, death, 1 year after PD start or March 2022, whichever came first. Primary outcomes were time to catheter patency failure and technique failure, and perioperative infectious complications within 30 days of catheter placement. Secondary outcomes were perioperative complications. Appropriate statistical analyses were performed to identify factors associated with the outcomes of interest. RESULTS Of the total 409 patients, 8 who underwent the embedded catheter technique did not have externalised catheters. Of the 401 remaining patients, catheter patency failure occurred in 25 (6.2%). Technical failure at 12 months after PD catheter placement calculated from cumulative incidence function was 15.3%. On Cox proportional hazards model analysis, serum albumin (hazard ratio (HR) 0.44; 95% confidence interval (CI) 0.27-0.70) and straight type catheter (HR 2.14; 95% CI 1.24-3.69) were the independent risk factors for technique failure. On logistic regression analysis, diabetes mellitus was the only independent risk factor for perioperative infectious complications (odds ratio 2.70, 95% CI 1.30-5.58). The occurrence rate of perioperative complications generally met the audit criteria of the ISPD guidelines. CONCLUSION PD catheter placement in Japan was proven to be safe and appropriate.
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Affiliation(s)
- Tsutomu Sakurada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Shigeki Kojima
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Shohei Yamada
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | | | - Yasuhiro Taki
- Department of Nephrology, Inagi Municipal Hospital, Tokyo, Japan
| | - Katsuomi Matsui
- Division of Nephrology and Hypertension, St Marianna University School of Medicine Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Masaru Murasawa
- Department of Nephrology, Gyotoku General Hospital, Chiba, Japan
| | - Hiroo Kawarazaki
- Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Sayaka Shimizu
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto University, Japan
| | - Hironori Kobayashi
- Department of Nephrology, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan
| | - Toshihiro Asai
- Department of Urology, Osaka City General Hospital, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, Nagano, Japan
| | - Taro Hoshino
- Department of Nephrology, Japanese Red Cross Saitama Hospital, Japan
| | - Seita Sugitani
- Department of Nephrology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Tomochika Maoka
- Department of Nephrology, NTT Medical Center Sapporo, Hokkaido, Japan
| | - Akihiko Nagase
- Department of Nephrology and Hypertension, Dokkyo Medical University, Tochigi, Japan
| | - Hirotaka Sato
- Department of Nephrology, Shimane Prefectural Central Hospital, Japan
| | - Kosuke Fukuoka
- Department of Nephrology, Kurashiki Central Hospital, Okayama, Japan
| | - Tadashi Sofue
- Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Japan
| | - Kiyoto Koibuchi
- Department of Nephrology and Dialysis, Saiseikai Yokohamashi Tobu Hospital, Japan
| | | | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | - Takayuki Okamoto
- Department of Nephrology, Kyowakai Medical Corporation Kyoritsu Hospital, Hyogo, Japan
| | - Daisuke Ishii
- Department of Urology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Satoshi Furukata
- Department of Nephrology, Fukaya Red Cross Hospital, Saitama, Japan
| | - Kiyotaka Uchiyama
- Department of Nephrology, International University of Health and Welfare Narita Hospital, Chiba, Japan
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Takahashi
- Department of Nephrology, National Hospital Organization Kure Medical Center, Hiroshima, Japan
| | - Yoshiko Nishizawa
- Department of Nephrology, Ichiyokai Harada Hospital, Hiroshima, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Naohiro Toda
- Department of Nephrology, Kansai Electric Power Hospital, Osaka, Japan
| | - Tsukasa Naganuma
- Department of Nephrology, Yamanashi Prefectural Central Hospital, Japan
| | - Hidetoshi Kikuchi
- Department of Nephrology, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Tomo Suzuki
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Daisuke Komukai
- Department of Nephrology, Kawasaki-Saiwai Hospital, Kanagawa, Japan
| | - Takahide Kimura
- Department of Nephrology, International University of Health and Welfare Atami Hospital, Shizuoka, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kazuhiro Yoshikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University School of Medicine, Japan
| | | | | | - Jin Oshikawa
- Department of Nephrology, Yokohama Sakae Kyosai Hospital, Kanagawa, Japan
| | - Keiichi Tamagaki
- Division of Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Hajime Fujisawa
- Department of Nephrology, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Atsushi Ueda
- Department of Nephrology, Hitachi General Hospital, Ibaraki, Japan
| | - Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | | | - Mai Yanagi
- Department of Nephrology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Takashi Udagawa
- Department of Nephrology, Nippon Koukan Hospital, Kanagawa, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Japan
| | - Masashi Sakai
- Department of Nephrology, Fujisawa City Hospital, Kanagawa, Japan
| | - Masanobu Gunji
- Department of Nephrology, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Shinichi Osaki
- Department of Surgery, Gengendo Kimitsu Hospital, Chiba, Japan
| | - Hisako Saito
- Department of Nephrology, Showa General Hospital, Tokyo, Japan
| | - Yuuki Yoshioka
- Department of Nephrology, Tachikawa General Hospital, Niigata, Japan
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Wright LK, Culp S, Gajarski RJ, Nandi D. Racial and socioeconomic disparities in status exceptions for pediatric heart transplant candidates under the current U.S. Pediatric Heart Allocation Policy. J Heart Lung Transplant 2023; 42:1233-1241. [PMID: 37088341 DOI: 10.1016/j.healun.2023.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND The 2016 revision of the US Pediatric Heart Allocation Policy developed stringent rules for priority status creating impetus for clinicians to seek status exceptions. We hypothesized there may be differential status exceptions based on race and socioeconomic status (SES) contributing to disparities in waitlist outcomes. METHODS The Scientific Registry for Transplant Recipients was queried for children listed for heart transplant from 2012 to 2020. Waitlist status & mortality with regards to race and neighborhood SES were stratified by listing before (Era 1) or after (Era 2) the policy change. RESULTS The use of both 1A and 1B exceptions (E) increased in Era 2. In Era 1, there was no association between patient race or neighborhood SES on use of 1A(E) or 1B(E) when controlling for age and diagnosis. In Era 2, neither race nor neighborhood SES were associated with 1A(E), but both were associated with 1B(E): non-Hispanic (NH) Black children and those from low- and middle-SES neighborhoods were significantly less likely to be listed 1B(E). In Era 1, there were no significant differences in waitlist mortality based on race at any waitlist status; in Era 2, NH Black children had higher waitlist mortality when initially listed 1B or 2. CONCLUSIONS Since the 2016 policy change, racial disparities in waitlist mortality have worsened among children initially listed with lower priority status. Unequal use of 1B exceptions, which lower waitlist mortality, may explain some of these disparities. Recently implemented standardized pediatric exception guidance has the potential to improve equity.
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Affiliation(s)
- Lydia K Wright
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
| | - Stacey Culp
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | | | - Deipanjan Nandi
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
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Bonenkamp AA, van Eck van der Sluijs A, Dekker FW, Struijk DG, de Fijter CW, Vermeeren YM, van Ittersum FJ, Verhaar MC, van Jaarsveld BC, Abrahams AC. Technique failure in peritoneal dialysis: Modifiable causes and patient-specific risk factors. Perit Dial Int 2023; 43:73-83. [PMID: 35193426 DOI: 10.1177/08968608221077461] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Technique survival is a core outcome for peritoneal dialysis (PD), according to Standardized Outcomes in Nephrology-Peritoneal Dialysis. This study aimed to identify modifiable causes and risk factors of technique failure in a large Dutch cohort using standardised definitions. METHODS Patients who participated in the retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes cohort study and started PD between 2012 and 2016 were included and followed until 1 January 2017. The primary outcome was technique failure, defined as transfer to in-centre haemodialysis for ≥ 30 days or death. Death-censored technique failure was analysed as secondary outcome. Cox regression models and competing risk models were used to assess the association between potential risk factors and technique failure. RESULTS A total of 695 patients were included, of whom 318 experienced technique failure during follow-up. Technique failure rate in the first year was 29%, while the death-censored technique failure rate was 23%. Infections were the most common modifiable cause for technique failure, accounting for 20% of all causes during the entire follow-up. Leakage and catheter problems were important causes within the first 6 months of PD treatment (both accounting for 15%). APD use was associated with a lower risk of technique failure (hazard ratio 0.66, 95% confidence interval 0.53-0.83). CONCLUSION Infections, leakage and catheter problems were important modifiable causes for technique failure. As the first-year death-censored technique failure rate remains high, future studies should focus on infection prevention and catheter access to improve technique survival.
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Affiliation(s)
- Anna A Bonenkamp
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands
| | | | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands
| | - Dirk G Struijk
- Department of Nephrology, Amsterdam UMC, University of Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands
| | - Carola Wh de Fijter
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Frans J van Ittersum
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research institute Amsterdam Cardiovascular Sciences, The Netherlands.,Diapriva Dialysis Center, Amsterdam, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
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Boyer A, Lanot A, Lambie M, Verger C, Guillouet S, Lobbedez T, Béchade C. Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF. Am J Nephrol 2021; 52:318-327. [PMID: 33906190 DOI: 10.1159/000515472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/24/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. METHODS This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. RESULTS There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95-0.97). Compared to 2009-2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81-0.96, and PR 0.91, 95% CI: 0.84-0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94-0.98). CONCLUSIONS Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.
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Affiliation(s)
- Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Mark Lambie
- Renal Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
- Faculty of Medicine and Health Sciences, Keele University, Newcastle, United Kingdom
| | | | - Sonia Guillouet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Clémence Béchade
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
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Wang Y, Li Y, Wang H, Ma Y, Ma D, Tian D, Liu B, Zhou Z, Yang W, Li X, Cui J, Chen L. Early-start and conventional-start peritoneal dialysis: a Chinese cohort study on outcome. Ren Fail 2020; 42:305-313. [PMID: 32208797 PMCID: PMC7144326 DOI: 10.1080/0886022x.2020.1743310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Early-start peritoneal dialysis (PD) is an effective option for patients need unplanned dialysis. However, there are few studies on the long-term prognosis of early-start PD patients. Methods In this retrospective study, 635 eligible patients from 1 March 1996 to 30 September 2016 were included, and divided into three groups according to the duration of break-in period: 3 days or less, 4–13 days and more than 14 days. Patients started PD within 2 weeks and after 2 weeks were defined as early-start and conventional-start, respectively. The primary outcome was all-cause mortality, and the secondary outcome measures were peritonitis free survival and technical survival. Mechanical and infectious complications in the first 180 days were also analyzed. Results Early-start PD patients were more likely to have higher serum total carbon dioxide and creatinine levels and lower serum albumin, Kt/v, creatinine clearance (Ccr) and residual glomerular filtration rate (rGFR) levels at the start of PD. The median follow-up period was 30 months (interquartile range, 13-53 months). A worse survival was observed in the early-start group than that in the conventional-start group (p < 0.001), even adjustment for the covariates (HR 1.549, 95%CI 1.104–2.173, p = 0.011). In the subgroup analysis, in patients commencing PD after 2006 early-start and conventional-start PD patients had comparable survival. No differences were observed in the rate of infectious and mechanical complications, peritonitis-free survival and technique survival between early-start and conventional-start PD patients. Conclusions Early-start PD could be a safe and effective strategy for patients needing unplanned dialysis initiation with the progress of technology on PD.
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Affiliation(s)
- Ying Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Haiyun Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Ma
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Danna Ma
- Nephrology Division, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Dongli Tian
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bingyan Liu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijuan Zhou
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Yang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Cui
- Nephrology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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9
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Ethier I, Cho Y, Hawley C, Pascoe EM, Roberts MA, Semple D, Nadeau-Fredette AC, Sypek MP, Viecelli A, Campbell S, van Eps C, Isbel NM, Johnson DW. Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis. Nephrol Dial Transplant 2020; 35:1938-1949. [PMID: 32031636 DOI: 10.1093/ndt/gfaa002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. METHODS The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. RESULTS Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. CONCLUSION Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.
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Affiliation(s)
- Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - David Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.,School of Medicine, University of Auckland, Auckland, New Zealand
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Hôpital Maisonneuve-Rosemont and Research Center, Université de Montréal, Montreal, Canada
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - Scott Campbell
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Carolyn van Eps
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.,Translational Research Institute, Brisbane, QLD, Australia
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10
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Yao YH, Chen CM, Chou YJ, Huang N. Impact of time-varying center volume on technique failure and mortality in peritoneal dialysis. Perit Dial Int 2020; 41:569-577. [PMID: 32729780 DOI: 10.1177/0896860820940449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Most studies on volume-outcome association used the number of patients at a particular period as the independent variable. However, peritoneal dialysis (PD) is a chronic treatment, and center volume usually changes over a patient's treatment period. Accordingly, this study used the time-varying center volume to explore the volume-outcome association in PD. METHODS We conducted a nationwide population-based retrospective cohort study, which included patients who began chronic PD between 2001 and 2010. The risk factors of 5-year technique failure and mortality were analyzed using cause-specific and subdistribution hazard models, respectively. The annual number of patients initiating PD in each patient's treatment center was modeled as a time-varying variable with four categories. RESULTS We included 9071 patients who started PD in 100 centers where the number of incident patients ranged from 1 to 107 patients per year (median, 25; interquartile range, 13-42). The estimated 5-year patient and technique survival rates were 64.7% and 66.6%, respectively. Being treated in centers in the largest volume category (the number of incident PD patients ≥43 per year) was associated with significantly lower cause-specific and cumulative hazards for technique failure. No association was found between facility volume and hazards of mortality. CONCLUSIONS Receiving PD in high-volume facilities was associated with a lower risk in technique failure. No association was found between facility volume and mortality risk.
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Affiliation(s)
- Yen-Hung Yao
- Division of Nephrology, Department of Medicine, 218818National Yang-Ming University Hospital, Yilan.,Institute of Public Health, School of Medicine, 34882National Yang-Ming University, Taipei
| | - Chyong-Mei Chen
- Institute of Public Health, School of Medicine, 34882National Yang-Ming University, Taipei
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, 34882National Yang-Ming University, Taipei
| | - Nicole Huang
- Institute of Hospital and Health Administration, School of Medicine, 34882National Yang-Ming University, Taipei
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11
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Cho Y, See EJ, Htay H, Hawley CM, Johnson DW. Early Peritoneal Dialysis Technique Failure: Review. Perit Dial Int 2020; 38:319-327. [DOI: 10.3747/pdi.2018.00017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/05/2018] [Indexed: 01/11/2023] Open
Abstract
There is a growing, global burden of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy. Although peritoneal dialysis (PD) is considered to be the most cost-effective dialysis modality, its utilization has been declining in some regions. The first year after starting PD is thought to be a vulnerable period for technique failure, which in turn contributes to poor patient retention. Improved understanding of the risk factors for technique failure during this period may help the development of targeted strategies to lower its incidence and improve both the utilization and utility of PD. This up-to-date review will summarize current evidence regarding the definition, incidence, causes, and predictors of early PD technique failure. Promising avenues for directing future research efforts will also be discussed.
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Affiliation(s)
- Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
| | - Emily J. See
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Carmel M. Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
| | - David W. Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
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12
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Vrtovsnik F, Verger C, Van Biesen W, Fan S, Shin SK, Rodríguez C, Garcia Méndez I, van der Sande FM, De Los Ríos T, Ihle K, Gauly A, Ronco C, Heaf J. The impact of volume overload on technique failure in incident peritoneal dialysis patients. Clin Kidney J 2019; 14:570-577. [PMID: 33623681 PMCID: PMC7886558 DOI: 10.1093/ckj/sfz175] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background Technique failure in peritoneal dialysis (PD) can be due to patient- and procedure-related factors. With this analysis, we investigated the association of volume overload at the start and during the early phase of PD and technique failure. Methods In this observational, international cohort study with longitudinal follow-up of incident PD patients, technique failure was defined as either transfer to haemodialysis or death, and transplantation was considered as a competing risk. We explored parameters at baseline or within the first 6 months and the association with technique failure between 6 and 18 months, using a competing risk model. Results Out of 1092 patients of the complete cohort, 719 met specific inclusion and exclusion criteria for this analysis. Being volume overloaded, either at baseline or Month 6, or at both time points, was associated with an increased risk of technique failure compared with the patient group that was euvolaemic at both time points. Undergoing treatment at a centre with a high proportion of PD patients was associated with a lower risk of technique failure. Conclusions Volume overload at start of PD and/or at 6 months was associated with a higher risk of technique failure in the subsequent year. The risk was modified by centre characteristics, which varied among regions.
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Affiliation(s)
| | - Christian Verger
- Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, The Royal London Hospital, London, UK
| | - Sug-Kyun Shin
- Department of Internal Medicine, NHIC ILsan Hospital, Koyang, Korea
| | - Carmen Rodríguez
- Nephrology Service, Hospital Universitario Central de Asturia, Oviedo, Spain
| | | | - Frank M van der Sande
- Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Tatiana De Los Ríos
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Katharina Ihle
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Adelheid Gauly
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
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13
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Lanot A, Bechade C, Verger C, Fabre E, Vernier I, Lobbedez T. Patterns of peritoneal dialysis catheter practices and technique failure in peritoneal dialysis: A nationwide cohort study. PLoS One 2019; 14:e0218677. [PMID: 31220171 PMCID: PMC6586404 DOI: 10.1371/journal.pone.0218677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/06/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure. Methods Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters. Results Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54–0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site. Conclusion Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study.
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Affiliation(s)
- Antoine Lanot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie université, Unicaen, UFR de médecine, Caen, France
- * E-mail:
| | - Clemence Bechade
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
| | | | | | - Isabelle Vernier
- RDPLF, Pontoise, France
- Néphrologie, polyclinique le Languedoc, Narbonne, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, CAEN, France
- Normandie université, Unicaen, UFR de médecine, Caen, France
- RDPLF, Pontoise, France
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14
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Chan C, Combes G, Davies S, Finkelstein F, Firanek C, Gomez R, Jager KJ, George VJ, Johnson DW, Lambie M, Madero M, Masakane I, McDonald S, Misra M, Mitra S, Moraes T, Nadeau-Fredette AC, Mukhopadhyay P, Perl J, Pisoni R, Robinson B, Ryu DR, Saran R, Sloand J, Sukul N, Tong A, Szeto CC, Van Biesen W. Transition Between Different Renal Replacement Modalities: Gaps in Knowledge and Care-The Integrated Research Initiative. Perit Dial Int 2019; 39:4-12. [PMID: 30692232 DOI: 10.3747/pdi.2017.00242] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/06/2018] [Indexed: 12/27/2022] Open
Abstract
Patients with end-stage kidney disease (ESKD) have different options to replace the function of their failing kidneys. The "integrated care" model considers treatment pathways rather than individual renal replacement therapy (RRT) techniques. In such a paradigm, the optimal strategy to plan and enact transitions between the different modalities is very relevant, but so far, only limited data on transitions have been published. Perspectives of patients, caregivers, and health professionals on the process of transitioning are even less well documented. Available literature suggests that poor coordination causes significant morbidity and mortality.This review briefly provides the background, development, and scope of the INTErnational Group Research Assessing Transition Effects in Dialysis (INTEGRATED) initiative. We summarize the literature on the transition between different RRT modalities. Further, we present an international research plan to quantify the epidemiology and to assess the qualitative aspects of transition between different modalities.
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Affiliation(s)
| | - Christopher Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Simon Davies
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | | | | | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, The Netherlands
| | | | | | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | - Ikuto Masakane
- Department of Nephrology, Yabuki Hospital, Yamagata, Japan
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, and University of Adelaide, Adelaide, Australia
| | - Madhukar Misra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, MO, USA
| | - Sandip Mitra
- Nephrology Department, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Thyago Moraes
- Nephrology, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | | | - Jeff Perl
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Rajiv Saran
- Division of Nephrology, Department of Medicine & Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - James Sloand
- Renal Division, Baxter Healthcare Corporation, Deerfield, IL, USA
| | - Nidhi Sukul
- Nephrology Department, University of Michigan, Ann Arbor, MI, USA
| | - Allison Tong
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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15
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Balzer MS, Claus R, Haller H, Hiss M. Are ISPD Guidelines on Peritonitis Diagnosis Too Narrow? A 15-Year Retrospective Single-Center Cohort Study on PD-Associated Peritonitis Accounting for Untrained Patients. Perit Dial Int 2019; 39:220-228. [DOI: 10.3747/pdi.2018.00179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/10/2018] [Indexed: 12/23/2022] Open
Abstract
Background Peritoneal dialysis (PD)-associated peritonitis remains by far the most important complication requiring patients to transfer to hemodialysis and has a major impact on patient morbidity and mortality. Current International Society for Peritoneal Dialysis (ISPD) guidelines on peritonitis recommend analysis of peritonitis episodes only in trained patients. In a large tertiary care center, we analyzed peritonitis episodes accounting for different groups of untrained patients and compared these with episodes in the trained patient population. Methods We analyzed data collected prospectively over a 15-year time span regarding differences between peritonitis episodes in trained patients and episodes in untrained patients post-catheter insertion but prior to training completion as well as on in-center intermittent PD with respect to incidence rates, pathogenic organisms, outcome, and peritonitis predictors. Results In 275 patients, a total of 160 peritonitis episodes in trained patients were counted. A total of 27 additional episodes in untrained patients were recorded. When accounting for these episodes, the peritonitis incidence significantly increased and the percentage of peritonitis-free patients decreased. Peritonitis episodes in untrained patients were most often culture-negative and the pathogen spectrum differed significantly compared with episodes counted as per ISPD recommendations, while outcome of peritonitis episodes did not differ. Predictors of peritonitis after multivariate logistic regression analysis included glomerulonephritis as primary kidney disease, being on home PD rather than being on in-center intermittent PD, and higher dialysis vintage. Conclusions Depending on local practice patterns, we argue that centers should additionally monitor peritonitis episodes in untrained patients because computation of statistics as per ISPD recommendations could underestimate peritonitis incidence and may depict a distorted pathogen spectrum.
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Affiliation(s)
- Michael S. Balzer
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Robert Claus
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Marcus Hiss
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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16
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Abstract
The series of papers that are included in this China Supplement to Peritoneal Dialysis International chart peritoneal dialysis (PD) research over the last several years in that country, provide detailed analysis of a large de-identified dataset from the Baxter Patient Support Program, and include 2 papers that describe clinical experiences relevant to the local context. These studies present a fascinating insight into the practice of PD in China, adding considerably to the sum of worldwide PD experience. China presents important opportunities for clinical research to answer key questions relevant to our therapy.
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17
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Wu C, Chen X, Ying Wang A, Chen J, Gao H, Li G, Wang L, Hong D. Peritoneal dialysis in Sichuan province of China - report from the Chinese National Renal Data System. Ren Fail 2018; 40:577-582. [PMID: 30343613 PMCID: PMC6201772 DOI: 10.1080/0886022x.2018.1496933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Peritoneal dialysis (PD) is one of the important treatment strategies for end stage renal disease (ESRD). In this study, we aimed to study the patients on PD of Sichuan province in the registry system and to explore the risk factors. Methods: This was a retrospective study based on data from the Chinese National Renal Data System (CNRDS). The outcomes were prevalence and incidence of patients receiving PD, all-cause mortality, technical failure, end events and peritonitis. Results: This study included 2654 patients between 1 January 2010 and 31 December 2016. From 2010 to 2016, despite there were increasing numbers of patients requiring PD. Primary and secondary glomerular diseases were the main causes of ESRD. Erythropoietin, iron and antihypertensive agents were the most commonly used medications in this cohort. 12.43% of patients died and the most important cause of death was cardiac events (30.30%). The incidences of peritonitis were 0.09, 0.16, 0.11, 0.09, 0.08, 0.12 and 0.06 per patient-year, respectively. The most common etiological agent of peritonitis was staphylococcus. We divided the patients into four groups according to the incident months of peritonitis. Compared with <20 months group, the level of calcium and platelet in >60 months group were higher, and the level of ferritin in >60 months group was lower. Conclusion: Our results, representing the first largest report of peritoneal dialysis in the Southwest of China, indicated increasing numbers of patients receiving peritoneal dialysis, which will require need for medical resource.
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Affiliation(s)
- Changwei Wu
- a Renal Department and Nephrology Institute , Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu , China
| | - Xiuling Chen
- a Renal Department and Nephrology Institute , Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu , China
| | - Amanda Ying Wang
- b The George Institute for Global Health, University of Sydney , Sydney , Australia
| | - Jin Chen
- a Renal Department and Nephrology Institute , Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu , China
| | - Hui Gao
- a Renal Department and Nephrology Institute , Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu , China
| | - Guisen Li
- a Renal Department and Nephrology Institute , Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu , China
| | - Li Wang
- a Renal Department and Nephrology Institute , Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu , China
| | - Daqing Hong
- a Renal Department and Nephrology Institute , Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu , China
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18
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Rottembourg J, Rostoker G. La réalité de la dialyse péritonéale en France : 40 ans après. Nephrol Ther 2018; 14:507-517. [DOI: 10.1016/j.nephro.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/03/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
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19
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Béchade C, Guillouët S, Verger C, Ficheux M, Lanot A, Lobbedez T. Centre characteristics associated with the risk of peritonitis in peritoneal dialysis: a hierarchical modelling approach based on the data of the French Language Peritoneal Dialysis Registry. Nephrol Dial Transplant 2018; 32:1018-1023. [PMID: 28472525 DOI: 10.1093/ndt/gfx051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/27/2017] [Indexed: 01/01/2023] Open
Abstract
Background. This study investigated the centre effect on the risk of peritonitis in peritoneal dialysis (PD) patients. Methods. This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analysed 5017 incident patients starting PD between January 2008 and December 2012 in 127 PD centres. The end of the observation period was 1 January 2014. The event of interest was the first peritonitis episode. The analysis was performed with a multilevel Cox model and a Fine and Gray model. Results. Among the 5017 patients, 3190 peritonitis episodes occurred in 1796 patients. There was significant heterogeneity between centres (variance of the random effect: 0.11). The variance of the centre effect was reduced by 9% after adjusting for patient characteristics and by 35% after adjusting on centre covariate. In the multivariate analysis with a multilevel Cox model, centre with a nurse specialized in PD or centre providing home visits before dialysis initiation decreased the centre effect on peritonitis. Patients treated in centres with a nurse specialized in PD or in centres providing home visits before dialysis initiation had a lower risk of peritonitis [cause-specific hazard ratio (cs-HR): 0.75 (95% confidence interval, CI, 0.67-0.83) and cs-HR: 0.87 (95% CI 0.76-0.97), respectively]. The data show that neither centre type nor centre volume influenced peritonitis risk. In the competing risk analysis, centre with a nurse specialized in PD and centre with home visits had a protective effect on peritonitis [sub-distribution HR (sd-HR): 0.77 (95% CI 0.70-0.85) and sd-HR: 0.85 (95% CI 0.77-0.94), respectively]. Conclusion. There is a significant centre effect on the risk of peritonitis that can be decreased by home visits before dialysis initiation and by the presence of a nurse specialized in PD.
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Affiliation(s)
| | | | | | | | | | - Thierry Lobbedez
- Néphrologie, CHU CAEN, 14000 CAEN CEDEX 9, France.,RDPLF, 95300 Pontoise, France
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20
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Htay H, Cho Y, Pascoe EM, Darssan D, Nadeau-Fredette AC, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP, Johnson DW. Center Effects and Peritoneal Dialysis Peritonitis Outcomes: Analysis of a National Registry. Am J Kidney Dis 2017; 71:814-821. [PMID: 29289475 DOI: 10.1053/j.ajkd.2017.10.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Peritonitis is a common cause of technique failure in peritoneal dialysis (PD). Dialysis center-level characteristics may influence PD peritonitis outcomes independent of patient-level characteristics. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Using Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data, all incident Australian PD patients who had peritonitis from 2004 through 2014 were included. PREDICTORS Patient- (including demographic data, causal organisms, and comorbid conditions) and center- (including center size, proportion of patients treated with PD, and summary measures related to type, cause, and outcome of peritonitis episodes) level predictors. OUTCOMES & MEASUREMENT The primary outcome was cure of peritonitis with antibiotics. Secondary outcomes were peritonitis-related catheter removal, hemodialysis therapy transfer, peritonitis relapse/recurrence, hospitalization, and mortality. Outcomes were analyzed using multilevel mixed logistic regression. RESULTS The study included 9,100 episodes of peritonitis among 4,428 patients across 51 centers. Cure with antibiotics was achieved in 6,285 (69%) peritonitis episodes and varied between 38% and 86% across centers. Centers with higher proportions of dialysis patients treated with PD (>29%) had significantly higher odds of peritonitis cure (adjusted OR, 1.21; 95% CI, 1.04-1.40) and lower odds of catheter removal (OR, 0.78; 95% CI, 0.62-0.97), hemodialysis therapy transfer (OR, 0.78; 95% CI, 0.62-0.97), and peritonitis relapse/recurrence (OR, 0.68; 95% CI, 0.48-0.98). Centers with higher proportions of peritonitis episodes receiving empirical antibiotics covering both Gram-positive and Gram-negative organisms had higher odds of cure with antibiotics (OR, 1.22; 95% CI, 1.06-1.42). Patient-level characteristics associated with higher odds of cure were younger age and less virulent causative organisms (coagulase-negative staphylococci, streptococci, and culture negative). The variation in odds of cure across centers was 9% higher after adjustment for patient-level characteristics, but 66% lower after adjustment for center-level characteristics. LIMITATIONS Retrospective study design using registry data. CONCLUSIONS These results suggest that center effects contribute substantially to the appreciable variation in PD peritonitis outcomes that exist across PD centers within Australia.
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Affiliation(s)
- Htay Htay
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Yeoungjee Cho
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Darsy Darssan
- Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia
| | | | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Monique Borlace
- Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia
| | - Sunil V Badve
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, St George Hospital, Sydney, Australia
| | - Kamal Sud
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Renal Medicine, Nepean Hospital, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, Australia; University of Sydney Medical School, Sydney, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Stephen P McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service; Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trial Network, Diamantina Institute, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
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Lambie M, Davies SJ. Are Peritoneal Dialysis Center Characteristics a Modifiable Risk Factor to Improve Peritoneal Dialysis Outcomes? Clin J Am Soc Nephrol 2017; 12:1032-1034. [PMID: 28637864 PMCID: PMC5498350 DOI: 10.2215/cjn.05260517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Keele, United Kingdom; and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
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Htay H, Cho Y, Pascoe EM, Darssan D, Nadeau-Fredette AC, Hawley C, Clayton PA, Borlace M, Badve SV, Sud K, Boudville N, McDonald SP, Johnson DW. Multicenter Registry Analysis of Center Characteristics Associated with Technique Failure in Patients on Incident Peritoneal Dialysis. Clin J Am Soc Nephrol 2017; 12:1090-1099. [PMID: 28637862 PMCID: PMC5498362 DOI: 10.2215/cjn.12321216] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Technique failure is a major limitation of peritoneal dialysis. Our study aimed to identify center- and patient-level predictors of peritoneal dialysis technique failure. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients on incident peritoneal dialysis in Australia from 2004 to 2014 were included in the study using data from the Australia and New Zealand Dialysis and Transplant Registry. Center- and patient-level characteristics associated with technique failure were evaluated using Cox shared frailty models. Death-censored technique failure and cause-specific technique failure were analyzed as secondary outcomes. RESULTS The study included 9362 patients from 51 centers in Australia. The technique failure rate was 0.35 (95% confidence interval, 0.34 to 0.36) episodes per patient-year, with a sevenfold variation across centers that was mainly associated with center-level characteristics. Technique failure was significantly less likely in centers with larger proportions of patients treated with peritoneal dialysis (>29%; adjusted hazard ratio, 0.83; 95% confidence interval, 0.73 to 0.94) and more likely in smaller centers (<16 new patients per year; adjusted hazard ratio, 1.10; 95% confidence interval, 1.00 to 1.21) and centers with lower proportions of patients achieving target baseline serum phosphate levels (<40%; adjusted hazard ratio, 1.15; 95% confidence interval, 1.03 to 1.29). Similar results were observed for death-censored technique failure, except that center target phosphate achievement was not significantly associated. Technique failure due to infection, social reasons, mechanical causes, or death was variably associated with center size, proportion of patients on peritoneal dialysis, and/or target phosphate achievement, automated peritoneal dialysis exposure, icodextrin use, and antifungal use. The variation of hazards of technique failure across centers was reduced by 28% after adjusting for patient-specific factors and an additional 53% after adding center-specific factors. CONCLUSIONS Technique failure varies widely across centers in Australia. A significant proportion of this variation is related to potentially modifiable center characteristics, including peritoneal dialysis center size, proportion of patients on peritoneal dialysis, and proportion of patients on peritoneal dialysis achieving target phosphate level.
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Affiliation(s)
- Htay Htay
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Chan S, Cho Y, Koh YH, Boudville NC, Clayton PA, McDonald SP, Pascoe EM, Francis RS, Mudge DW, Borlace M, Badve SV, Sud K, Hawley CM, Johnson DW. Association of Socio-Economic Position with Technique Failure and Mortality in Australian Non-Indigenous Peritoneal Dialysis Patients. Perit Dial Int 2017; 37:397-406. [PMID: 28183859 DOI: 10.3747/pdi.2016.00209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/03/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few studies have examined the relationship between socio-economic position (SEP) and peritoneal dialysis (PD) outcomes, particularly at a country level. The aim of this study was to investigate the relationships between SEP, technique failure, and mortality in PD patients undertaking treatment in Australia. METHODS The study included all Australian non-indigenous incident PD patients between January 1, 1997, and December 31, 2014, using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. The SEP was assessed by quartiles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Advantage and Disadvantage (IRSAD - primary index), Index of Relative Socio-economic Disadvantage (IRSD), Index of Economic Resources (IER), and Index of Education and Occupation (IEO). Technique and patient survival were evaluated by multivariable Cox proportional hazards survival analyses. RESULTS The study included 9,766 patients (mean age 60.6 ± 15 years, 57% male, 38% diabetic). Using multivariable Cox regression, no significant association was observed between quartiles of IRSAD and technique failure (30-day definition p = 0.65, 180-day definition p = 0.68). Similar results were obtained using competing risks regression. However, higher SEP, defined by quartiles of IRSAD, was associated with better patient survival (Quartile 1 reference; Quartile 2 adjusted hazards ratio [HR] 0.96, 95% confidence interval [CI] 0.86 - 1.06; Quartile 3 HR 0.87, 95% CI 0.77 - 0.99; Quartile 4 HR 0.86, 95% CI 0.76 - 0.97). Similar results were found when IRSD was analyzed, but results were no longer statistically significant for IER and IEO. CONCLUSIONS In Australia, where there is universal free healthcare, SEP was not associated with PD technique failure in non-indigenous PD patients. Higher SEP was generally associated with improved patient survival.
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Affiliation(s)
- Samuel Chan
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Yung H Koh
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Neil C Boudville
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia
| | - Philip A Clayton
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen P McDonald
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Elaine M Pascoe
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ross S Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David W Mudge
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Monique Borlace
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Sunil V Badve
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, St. George Hospital, Sydney, Australia
| | - Kamal Sud
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Departments of Renal Medicine, Nepean and Westmead Hospitals, Sydney, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide
| | - Carmel M Hawley
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David W Johnson
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia .,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Affiliation(s)
- Thyago de Moraes
- School of Medicine, Pontificia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Jeffrey Perl
- St. Michael's Hospital, Toronto, Ontario, Canada
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