Abstract: FR-PO445
Comparative Outcomes of Peritoneal Dialysis across Different Hospital Settings: An Analysis of Urban Teaching, Urban Nonteaching, and Rural Hospitals
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Suppadungsuk, Supawadee, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Kaewput, Wisit, Phramongkutklao Hospital, Bangkok, Thailand
- Davis, Paul W., Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Tangpanithandee, Supawit, Chakri Naruebodin Medical Institute, Bang Phli, Samut Prakan, Thailand
- Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
Patients with end-stage kidney disease (ESKD) receiving peritoneal dialysis (PD) are treated in a variety of hospital settings, including urban teaching, urban non-teaching, and rural hospitals. Understanding the differences in clinical characteristics, treatments, outcomes, and resource utilization specific to these hospital types is crucial for optimizing patient care.
Methods
This study utilized the National Inpatient Sample to identify hospitalized ESKD patients receiving PD in the United States from 2003 to 2018, The in-hospital treatments, outcomes, and resource utilization were compared across urban teaching, urban nonteaching, and rural hospitals.
Results
The study included 99,528 hospitalized ESKD patients receiving PD. Notable differences were observed across hospital types. The mean age was 57.2±16.1 years overall, with rural hospitals having older patients (59.5±16.1 years). The study population was 49.8% male. Racial distribution varied significantly, with rural hospitals having a higher proportion of White patients (70.4%). Charlson comorbidity scores were similar across all hospitals, with a median score of 4 (IQR 3-5). Hospitalization year, primary payer, and patient income levels varied significantly. Rural hospitals had shorter hospital stays (4 vs. 5 days) and lower costs ($19,534.5 vs. $31,583.5). Urban nonteaching and rural hospitals had slightly lower odds for PD catheter adjustments and lower odds of mechanical ventilation and palliative care. However, they had higher odds of peritonitis. Adjusted mortality odds were lower in rural hospitals (OR 0.72, 95% CI 0.59-0.87).
Conclusion
Significant differences in clinical characteristics, treatments, outcomes, and resource utilization were observed among hospitalized ESKD patients receiving PD across urban teaching, urban nonteaching, and rural hospitals. These findings emphasize the need for tailored approaches to optimize patient care based on the specific characteristics and needs of each hospital setting.