TECHNIQUE FAILURE AND CENTER SIZE IN A LARGE COHORT OF PERITONEAL DIALYSIS PATIENTS IN A DEFINED GEOGRAPHIC AREA

• Published in: Peritoneal dialysis international 2009-05, Vol.29 (3), p.292-296
• Main Authors: Afolalu, Bayode, Troidle, Laura, Osayimwen, Osasu, Bhargava, Jaya, Kitsen, Jenny, Finkelstein, Fredric O
• Format: Article
• Language: English
• Subjects: Ambulatory Care Facilities - organization & administration; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Catchment Area, Health; Cohort Studies; Databases, Factual; Emergency and intensive care: renal failure. Dialysis management; Female; Health Facility Size; Humans; Intensive care medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - mortality; Peritoneal Dialysis - statistics & numerical data; Renal failure; Retrospective Studies; Treatment Failure; United States
• ISSN: 0896-8608; 1718-4304
• DOI: 10.1177/089686080902900313

Hospital of St. Raphael, 1 New Haven CAPD, 2 Renal Research Institute, 3 Network of New England (Network #1), 4 and Yale University, 5 New Haven, Connecticut, USA Correspondence to: F.O. Finkelstein, Department of Nephrology, Hospital of St. Raphael, 1450 Chapel Street, New Haven, Connecticut 06511 USA. fof{at}comcast.net Background : Hemodialysis (HD) and peritoneal dialysis (PD) are both viable options for renal replacement therapy. Technique failure has been shown to be a major problem in PD therapy. Objective : To examine the relationship between center size and PD technique failure. Setting : ESRD Network #1 (NW1). Design : Retrospective review of NW1 database. Patients and Methods : 5003 incident PD patients between 2001 and 2005 in 105 PD units were included. Patients were grouped into 2 based on center size: group A, patients in units with 25 patients, and group B, patients in units with >25 patients. Outcome measures were analyzed for the first and second years of PD therapy. Patients were censored at transplantation, transfer to HD, or death. Outcome Measures : Technique failure and mortality reported as death in Standard Information Management Systems (SIMS) database (NW1 data system). Results : Technique failure rates were significantly higher in group A for year 1 (odds ratio: 1.36, p = 0.005) and for year 2 (odds ratio: 1.35, p = 0.03). Mortality rates were not statistically different between the 2 groups. Conclusion : Technique failure was higher in units with 25 patients than in units with >25 patients. There was no difference in mortality between the 2 groups. The majority of patients in NW1 receive care in small units. KEY WORDS: Center size; technique failure. Received 5 May 2008; accepted 7 August 2008.