TY - JOUR
T1 - Comorbidity and other factors associated with modality selection in incident dialysis patients
T2 - The CHOICE study
AU - Miskulin, Dana C.
AU - Meyer, Klemens B.
AU - Athienites, Nicolaos V.
AU - Martin, Alice A.
AU - Norma, Terrin
AU - Marsh, Jane V.
AU - Fink, Nancy E.
AU - Josef, Coresh
AU - Powe, Neil R.
AU - Klag, Mike J.
AU - Levey, Andrew S.
N1 - Funding Information:
Supported in part by a grant from the Agency for Healthcare Research and Quality (AHRQ) (formerly Agency for Health Care Policy Research [AHCPR] HS08365 to N.R.P.) and a Clinical Research Fellowship from the Alberta Heritage Foundation for Medical Research (to D.C.M.).
Funding Information:
The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study is a Patient Outcomes Research Team (PORT) funded by the Agency for Healthcare Research and Quality. 17 One of the projects, the CHOICE Cohort Study, is a prospective study of the relationship of dialysis modality and dose to subsequent outcomes in incident dialysis patients. It includes a comprehensive cross-sectional and longitudinal assessment of comorbid factors in 279 PD and 759 HD patients between 1995 through 1999. The objective of the present report is to compare the baseline characteristics of the PD and HD patients, with special emphasis on comorbid conditions, and to assess the relationship of patient characteristics to modality selection.
PY - 2002
Y1 - 2002
N2 - Case-mix factors influence both the selection of dialysis modality and outcomes in end-stage renal disease (ESRD). A detailed characterization of the case-mix differences between peritoneal dialysis (PD) and hemodialysis (HD) patients at the onset of dialysis therapy has not been performed, despite the importance of accounting for baseline differences in future comparisons of outcomes across modality groups. We compared baseline characteristics of 279 PD and 759 HD patients enrolled in the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Cohort Study, a prospective study of incident dialysis patients. Comorbidity was assessed using the Index of Coexistent Diseases (ICED), consisting of a medical record review of 19 medical conditions and an observer-based assessment of 11 physical functions. ICED scores range from 0 to 3, with higher levels reflecting more severe comorbidity. Comorbidity was less severe in PD patients than in HD patients: the proportions of patients with ICED 0-1, ICED 2, and ICED 3 were 52%, 26%, and 22%, respectively, among the PD patients and 30%, 39%, and 31%, respectively, among the HD patients (P < 0.001). After controlling for all other factors, the differences in comorbidity remained significant. As compared with patients with ICED 0-1, the odds of being treated with PD for patients with ICED 2 and ICED 3 were less (odds ratio [OR] and 95% confidence intervals) 0.31 (0.17 to 0.56) and 0.50 (0.28 to 0.90), respectively. The number and severity of comorbid conditions at the onset of ESRD is significantly lower in patients choosing PD, independent of other factors influencing modality selection. The increased survival of PD patients reported in recent studies may simply reflect the self- or physician-directed selection of healthier patients to PD. Adjustment for case-mix differences in patients treated with PD versus HD is essential to the assessment of the independent effect of the dialysis modality on outcomes.
AB - Case-mix factors influence both the selection of dialysis modality and outcomes in end-stage renal disease (ESRD). A detailed characterization of the case-mix differences between peritoneal dialysis (PD) and hemodialysis (HD) patients at the onset of dialysis therapy has not been performed, despite the importance of accounting for baseline differences in future comparisons of outcomes across modality groups. We compared baseline characteristics of 279 PD and 759 HD patients enrolled in the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Cohort Study, a prospective study of incident dialysis patients. Comorbidity was assessed using the Index of Coexistent Diseases (ICED), consisting of a medical record review of 19 medical conditions and an observer-based assessment of 11 physical functions. ICED scores range from 0 to 3, with higher levels reflecting more severe comorbidity. Comorbidity was less severe in PD patients than in HD patients: the proportions of patients with ICED 0-1, ICED 2, and ICED 3 were 52%, 26%, and 22%, respectively, among the PD patients and 30%, 39%, and 31%, respectively, among the HD patients (P < 0.001). After controlling for all other factors, the differences in comorbidity remained significant. As compared with patients with ICED 0-1, the odds of being treated with PD for patients with ICED 2 and ICED 3 were less (odds ratio [OR] and 95% confidence intervals) 0.31 (0.17 to 0.56) and 0.50 (0.28 to 0.90), respectively. The number and severity of comorbid conditions at the onset of ESRD is significantly lower in patients choosing PD, independent of other factors influencing modality selection. The increased survival of PD patients reported in recent studies may simply reflect the self- or physician-directed selection of healthier patients to PD. Adjustment for case-mix differences in patients treated with PD versus HD is essential to the assessment of the independent effect of the dialysis modality on outcomes.
KW - Case-mix
KW - Comorbidity
KW - Risk adjustment
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U2 - 10.1053/ajkd.2002.30552
DO - 10.1053/ajkd.2002.30552
M3 - Article
C2 - 11840373
AN - SCOPUS:0036183370
SN - 0272-6386
VL - 39
SP - 324
EP - 336
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -