Impact of Modality Choice on Rates of Hospitalization in Patients Eligible for Both Peritoneal Dialysis and Hemodialysis

Overview

Journal Perit Dial Int

Publisher Sage Publications

Date 2014 Feb 15

PMID 24525596

Citations 13

Authors

Robert R Quinn

Pietro Ravani

Xin Zhang

Amit X Garg

Peter G Blake

Peter C Austin

James M Zacharias

John F Johnson

Sanjay Pandeya

Mauro Verrelli

Matthew J Oliver

Affiliations

Soon will be listed here.

Abstract

Unlabelled:

Background: Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality. Previous comparisons of peritoneal dialysis (PD) and hemodialysis (HD) have not been restricted to individuals who were eligible for both therapies. ♢

Methods: We conducted a multicenter prospective cohort study of people 18 years of age and older who were eligible for both PD and HD, and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs. Zero-inflated negative binomial models, adjusted for baseline patient characteristics, were used to examine the association between modality choice and rates of hospitalization. ♢

Results: The study enrolled 314 patients. A trend in the HD group toward higher rates of hospitalization, observed in the primary analysis, became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care. Cardiovascular disease, infectious complications, and elective surgery were the most common reasons for hospital admission; only 23% of hospital stays were directly related to complications of dialysis or kidney disease. ♢

Conclusions: Efforts to promote PD utilization are unlikely to result in increased rates of hospitalization, and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications.

Citing Articles

Peritoneal dialysis versus haemodialysis for people commencing dialysis.

Ethier I, Hayat A, Pei J, Hawley C, Johnson D, Francis R Cochrane Database Syst Rev. 2024; 6:CD013800.

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Differences in hospitalisation between peritoneal dialysis and haemodialysis patients.

van Eck van der Sluijs A, Bonenkamp A, van Wallene V, Hoekstra T, Lissenberg-Witte B, Dekker F Eur J Clin Invest. 2022; 52(6):e13758.

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Do remote dialysis services really cost more? An economic analysis of hospital and dialysis modality costs associated with dialysis services in urban, rural and remote settings.

Gorham G, Howard K, Cunningham J, Barzi F, Lawton P, Cass A BMC Health Serv Res. 2021; 21(1):582.

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Sex differences in the vascular access of hemodialysis patients: a cohort study.

MacRae J, Clarke A, Ahmed S, Elliott M, Quinn R, James M Clin Kidney J. 2021; 14(5):1412-1418.

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Starting Dialysis on Time, At Home on the Right Therapy (START): Description of an Intervention to Increase the Safe and Effective Use of Peritoneal Dialysis.

Quinn R, Mohamed F, Pauly R, Schwartz T, Scott-Douglas N, Morrin L Can J Kidney Health Dis. 2021; 8:20543581211003764.

PMID: 33868692 PMC: 8020238. DOI: 10.1177/20543581211003764.

References

CARLSON D, Duncan D, Naessens J, Johnson W . Hospitalization in dialysis patients. Mayo Clin Proc. 1984; 59(11):769-75. DOI: 10.1016/s0025-6196(12)65588-8. View

Habach G, Bloembergen W, Mauger E, Wolfe R, Port F . Hospitalization among United States dialysis patients: hemodialysis versus peritoneal dialysis. J Am Soc Nephrol. 1995; 5(11):1940-8. DOI: 10.1681/ASN.V5111940. View

Quinn R, Laupacis A, Hux J, Oliver M, Austin P . Predicting the risk of 1-year mortality in incident dialysis patients: accounting for case-mix severity in studies using administrative data. Med Care. 2011; 49(3):257-66. DOI: 10.1097/MLR.0b013e318202aa0b. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596):1453-7. DOI: 10.1016/S0140-6736(07)61602-X. View

Bovbjerg R, Diamond L, Held P, Pauly M . Continuous ambulatory peritoneal dialysis: preliminary evidence in the debate over efficacy and cost. Health Aff (Millwood). 1983; 2(2):96-102. DOI: 10.1377/hlthaff.2.2.96. View

Metcalfe W, Khan I, Prescott G, Simpson K, MacLeod A . Can we improve early mortality in patients receiving renal replacement therapy?. Kidney Int. 2000; 57(6):2539-45. DOI: 10.1046/j.1523-1755.2000.00113.x. View

Evans R, Manninen D, Garrison Jr L, HART L, Blagg C, Gutman R . The quality of life of patients with end-stage renal disease. N Engl J Med. 1985; 312(9):553-9. DOI: 10.1056/NEJM198502283120905. View

Oliver M, Garg A, Blake P, Johnson J, Verrelli M, Zacharias J . Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization. Nephrol Dial Transplant. 2010; 25(8):2737-44. DOI: 10.1093/ndt/gfq085. View

Oliver M, Verrelli M, Zacharias J, Blake P, Garg A, Johnson J . Choosing peritoneal dialysis reduces the risk of invasive access interventions. Nephrol Dial Transplant. 2011; 27(2):810-6. DOI: 10.1093/ndt/gfr289. View

10.

Albert J, Wang W, Nelson S . Estimating overall exposure effects for zero-inflated regression models with application to dental caries. Stat Methods Med Res. 2011; 23(3):257-78. PMC: 3809340. DOI: 10.1177/0962280211407800. View

11.

Murphy S, Foley R, Barrett B, Kent G, Morgan J, Barre P . Comparative hospitalization of hemodialysis and peritoneal dialysis patients in Canada. Kidney Int. 2000; 57(6):2557-63. DOI: 10.1046/j.1523-1755.2000.00115.x. View

12.

Williams A, Nicholl J, El Nahas A, Moorhead P, Plant M, Brown C . Continuous ambulatory peritoneal dialysis and haemodialysis in the elderly. Q J Med. 1990; 74(274):215-23. View

13.

Lee H, Manns B, Taub K, Ghali W, Dean S, Johnson D . Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access. Am J Kidney Dis. 2002; 40(3):611-22. DOI: 10.1053/ajkd.2002.34924. View

14.

Singh S, Yium J, Macon E, Clark E, Schaffer D, TESCHAN P . Multicenter study of change in dialysis therapy-maintenance hemodialysis to continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 1992; 19(3):246-51. DOI: 10.1016/s0272-6386(13)80005-4. View

15.

Burton P, Walls J . A selection adjusted comparison of hospitalization on continuous ambulatory peritoneal dialysis and haemodialysis. J Clin Epidemiol. 1989; 42(6):531-9. DOI: 10.1016/0895-4356(89)90149-2. View

16.

Quinn R, Hux J, Oliver M, Austin P, Tonelli M, Laupacis A . Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol. 2011; 22(8):1534-42. PMC: 3148708. DOI: 10.1681/ASN.2010121232. View

17.

Harris S, Lamping D, Brown E, Constantinovici N . Clinical outcomes and quality of life in elderly patients on peritoneal dialysis versus hemodialysis. Perit Dial Int. 2002; 22(4):463-70. View

18.

De Vecchi A, Dratwa M, Wiedemann M . Healthcare systems and end-stage renal disease (ESRD) therapies--an international review: costs and reimbursement/funding of ESRD therapies. Nephrol Dial Transplant. 1999; 14 Suppl 6:31-41. DOI: 10.1093/ndt/14.suppl_6.31. View

19.

SERKES K, Blagg C, Nolph K, Vonesh E, Shapiro F . Comparison of patient and technique survival in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis: a multicenter study. Perit Dial Int. 1990; 10(1):15-9. View

20.

Bremer B, McCauley C, Wrona R, Johnson J . Quality of life in end-stage renal disease: a reexamination. Am J Kidney Dis. 1989; 13(3):200-9. DOI: 10.1016/s0272-6386(89)80053-8. View