Association of peritoneal dialysis clinic size with clinical outcomes

Laura C. Plantinga, Nancy E. Fink, Fredric O. Finkelstein, Neil R. Powe, Bernard 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
StatePublished - 2009

Fingerprint

Peritoneal Dialysis
Renal Dialysis
Mortality
Proxy
Proportional Hazards Models
Comorbidity
Cause of Death
Cohort Studies
Demography
Prospective Studies

Keywords

  • Cardiovascular morbidity
  • Clinic size
  • Mortality
  • Technique failure

ASJC Scopus subject areas

  • Nephrology

Cite this

Plantinga, L. C., Fink, N. E., Finkelstein, F. O., Powe, N. R., & Jaar, B. (2009). Association of peritoneal dialysis clinic size with clinical outcomes. Peritoneal Dialysis International, 29(3), 285-291.

Association of peritoneal dialysis clinic size with clinical outcomes. / Plantinga, Laura C.; Fink, Nancy E.; Finkelstein, Fredric O.; Powe, Neil R.; Jaar, Bernard.

In: Peritoneal Dialysis International, Vol. 29, No. 3, 2009, p. 285-291.

Research output: Contribution to journalArticle

Plantinga, LC, Fink, NE, Finkelstein, FO, Powe, NR & Jaar, B 2009, 'Association of peritoneal dialysis clinic size with clinical outcomes', Peritoneal Dialysis International, vol. 29, no. 3, pp. 285-291.
Plantinga, Laura C. ; Fink, Nancy E. ; Finkelstein, Fredric O. ; Powe, Neil R. ; Jaar, Bernard. / Association of peritoneal dialysis clinic size with clinical outcomes. In: Peritoneal Dialysis International. 2009 ; Vol. 29, No. 3. pp. 285-291.
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