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Clinical Experience |
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Objective: Offering home care assistance increases the number of
patients (pts) who are eligible for peritoneal dialysis (PD) and may increase
PD utilization. There is concern that managing older, sicker pts in the home
may increase the risk of adverse events. The primary objective of this study
is to determine if home care assisted PD is associated with an increased risk
of hospitalization compared to hemodialysis (HD). Methods: We
followed all incident dialysis pts at Sunnybrook Health Sciences Centre in
Toronto, Canada, from 1 January 2004 until 31 July 2006. We identified 105 pts
who were eligible for both PD (with or without assistance) and HD based on a
rigorous multidisciplinary assessment and followed them for a median of 621
days. Pts were offered both therapies and allowed to choose their chronic
dialysis modality. Baseline demographic, comorbidity, and treatment
information was collected on all pts and the total number of hospital
admissions and days spent in hospital were recorded. Poisson regression was
used to calculate the relative rate of hospitalization in pts on home care
assisted PD compared to HD after adjustment for age, sex, diabetes,
predialysis care, and in-pt dialysis start. Results: 57% of incident
pts chose PD. Pts who chose PD were more likely to have received predialysis
care (92% vs 57%, p=0.0004) and 33% required assistance at the start
of dialysis. The PD group was hospitalized 1.4 times per year for a total of
23.6 days compared to 1.2 admissions and 24.2 days per year in the HD group.
After adjustment for baseline pt characteristics, there was no significant
difference in rates of hospitalization between the 2 groups (rate ratio 0.91;
p=0.4165). There was no difference in the rates of hospitalization
between self-care PD, assisted PD, and traditional HD (p=0.4892).
Conclusions: There does not appear to be an increased risk of
hospitalization in pts who choose home care assisted PD compared to
traditional, in-center HD. Larger studies are required to confirm this finding
and to ensure that rates of other important adverse events are not increased
when we expand eligibility for PD by offering home care assistance.
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