TY - JOUR
T1 - Association of peritoneal dialysis clinic size with clinical outcomes
AU - Plantinga, Laura C.
AU - Fink, Nancy E.
AU - Finkelstein, Fredric O.
AU - Powe, Neil R.
AU - Jaar, Bernard G.
PY - 2009
Y1 - 2009
N2 - ◆ 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.
AB - ◆ 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.
KW - Cardiovascular morbidity
KW - Clinic size
KW - Mortality
KW - Technique failure
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U2 - 10.1177/089686080902900312
DO - 10.1177/089686080902900312
M3 - Article
C2 - 19458300
AN - SCOPUS:67649342194
SN - 0896-8608
VL - 29
SP - 285
EP - 291
JO - Peritoneal Dialysis International
JF - Peritoneal Dialysis International
IS - 3
ER -