Abstract: FR-PO449
Higher Peritoneal Dialysis (PD) Facility Census Is Associated with Better PD-Specific Outcomes
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
- Knapp, Christopher D., Hennepin Healthcare System Inc, Minneapolis, Minnesota, United States
- Johansen, Kirsten L., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
- Li, Shuling, Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background
Patients who receive PD care at facilities with more PD patients have lower rates of conversion to in-center hemodialysis (ICHD). It is not clear if a higher PD facility census is associated with differences in other outcomes.
Methods
We used the US Renal Data System to identify a cohort of incident PD patients from 2014-2018. Patients were categorized into 3 groups according to the year-end PD census at their initial PD facility: <11, 11-25 and >25 patients. All patients were followed up to one year for mortality and conversion to ICHD. A sub-cohort with Medicare fee-for-service coverage at PD initiation was followed for outcomes of hospitalization for peritonitis or cardiovascular disease (CVD). We used Cox models to estimate the hazards ratios (HR) for mortality, peritonitis, and CVD hospitalization and Fine-Gray competing risk models for conversion to in-center HD. Hazards for each outcome for the PD-census groups were compared.
Results
Of 58,219 PD patients, 15% were managed in a facility with a census of <11 patients, with 32% and 53% in facilities with PD censuses of 11-25 and >25, respectively. Patients in the <11 census group were more likely to be White and to live in non-urban areas. Unadjusted hazards for each outcome were higher for patients managed in lower census facilities (Table). After adjustment, the hazards of conversion to ICHD and peritonitis hospitalization were 6% and 11% higher, respectively (HR 1.06, 95% CI 1.01-1.11 for conversion, HR 1.11, 95% CI 1.01-1.22 for peritonitis) for patients in the 11-25 census group, but they had a 7% lower hazard of mortality compared with the >25 group (HR 0.93, 95% CI 0.87-0.99). Patients in the <11 group had a 20% higher hazard of conversion to ICHD compared with patients in the >25 group (HR 1.20, 95% CI 1.13-1.28).
Conclusion
A high facility PD census was associated with better PD-specific outcomes like peritonitis and conversion to ICHD but not with lower mortality.
Funding
- NIDDK Support