Association of peritoneal dialysis clinic size with clinical outcomes

Laura C. Plantinga, Nancy E. Fink, Fredric O. Finkelstein, Neil R. Powe, Bernard G. Jaar

Research output: Contribution to journalArticle

Abstract

◆ Objective: Very few studies have addressed the relationship between number of peritoneal dialysis (PD) patients treated at a clinic (PD clinic size) and clinical outcomes. In a national prospective cohort study of incident PD patients (n = 236, from 26 clinics), we examined whether being treated at a larger PD clinic [>50 PD patients (n = 3 clinics) vs ≤50 PD patients (n = 23 clinics)] was associated with better patient outcomes, including fewer switches to hemodialysis, fewer cardiovascular events, lower cardiovascular mortality, and lower all-cause mortality. ◆ Methods: Multivariable Cox models were used to assess relative hazards (RHs) for modality switches, cardiovascular events, cardiovascular deaths, and all-cause deaths by PD clinic size. All models were adjusted for demographics, comorbidities, laboratory values, and clinic years in operation. ◆ Results: Being treated at a clinic with >50 patients was associated with fewer switches to hemodialysis (RH = 0.13, 95% CI 0.06 - 0.31) and fewer cardiovascular events (RH = 0.62, 95% CI 0.06 - 0.98). No associations of PD clinic size with cardiovascular or all-cause mortality were seen. ◆ Conclusion: PD patients treated at clinics with greater numbers of PD patients may have better outcomes in terms of technique failure and cardiovascular morbidity. PD clinic size may act as a proxy of greater PD experience, more focus on the modality, and better PD practices at the clinic, resulting in better outcomes.

Original languageEnglish (US)
Pages (from-to)285-291
Number of pages7
JournalPeritoneal Dialysis International
Volume29
Issue number3
DOIs
StatePublished - 2009

Keywords

  • Cardiovascular morbidity
  • Clinic size
  • Mortality
  • Technique failure

ASJC Scopus subject areas

  • Nephrology

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