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Perit Dial Int 29(3): 285-291
2009
© 2009 International Society for Peritoneal Dialysis
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Clinical

ASSOCIATION OF PERITONEAL DIALYSIS CLINIC SIZE WITH CLINICAL OUTCOMES

Laura C. Plantinga1, Nancy E. Fink1,2, Fredric O. Finkelstein3, Neil R. Powe1,2,4 and Bernard G. Jaar1,2,5

Department of Epidemiology,1 Johns Hopkins Bloomberg School of Public Health; Department of Medicine,2 Johns Hopkins University School of Medicine, Baltimore, Maryland; Yale University,3 New Haven, Connecticut; Department of Health Policy and Management,4 Johns Hopkins Bloomberg School of Public Health; Nephrology Center of Maryland,5 Baltimore, Maryland, USA

Correspondence to: B.G. Jaar, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, 2024 E. Monument St., Suite 2-500, Baltimore, Maryland 21287 USA. bjaar{at}jhmi.edu

{diamondsuit} 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.

{diamondsuit} 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.

{diamondsuit} 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.

{diamondsuit} 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.

KEY WORDS: Clinic size; technique failure; cardiovascular morbidity; mortality.

Received 28 March 2008; accepted 8 September 2008.




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