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Multicenter Study
. 2009 May-Jun;29(3):285-91.

Association of peritoneal dialysis clinic size with clinical outcomes

Laura C Plantinga  1 , Nancy E Fink, Fredric O Finkelstein, Neil R Powe, Bernard G Jaar
Affiliations
Multicenter Study

Association of peritoneal dialysis clinic size with clinical outcomes

Laura C Plantinga et al. Perit Dial Int. 2009 May-Jun.

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 <or=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.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier curve of cumulative modality switch to HD by PD clinic size. P<0.001 by log-rank test.
Fig. 2
Fig. 2
Kaplan-Meier curve of cumulative cardiovascular event incidence by PD clinic size. P=0.007 by log-rank test.
See this image and copyright information in PMC

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