Comparing outcomes in renal replacement therapy: How should we correct for case mix?

Khan, Izhar; Campbell, Marion K; Cantarovich, Diego; Catto, G. R. D.; Delcroix, Catherine; Edward, N.; Fontenaille, Ch.; Hamersvelt, Henk W. van; Henderson, I.A.; Koene, R. A. P.; Papadimitriou, M.; Ritz, Eberhard; Ramsay, Colin A.; Tsakiris, D.; MacLeod, Alison Murray

doi:10.1053/ajkd.1998.v31.pm9506684

Cited by 23 publications

(23 citation statements)

References 12 publications

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“…Hence, the two studied populations were comparable with respect to the mentioned criteria. Furthermore, the comorbidity index [10] was comparable in both populations.…”

Section: Discussionmentioning

confidence: 76%

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Outcome of home haemodialysis patients: a case-cohort study

Saner¹,

Nitsch²,

Descoeudres³

et al. 2005

Nephrology Dialysis Transplantation

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Background. Randomized, controlled comparisons between home haemodialysis (HHD) and centre haemodialysis (CHD) have not been performed to date. Reported survival benefits of HHD as compared with CHD from uncontrolled studies have been attributed largely to patient selection. Methods. In order to minimize a selection bias, we have compared the outcome of our HHD and CHD patients with a nested case-cohort study. For each patient trained for HHD at our dialysis centre between 1970 and 1995 (n ¼ 103), a corresponding match was searched from the CHD patients by retrospective chart analysis. The pairs were matched for sex, age (±5 years), time of dialysis therapy onset (±2 years) and renal disease category. For 58 of the 103 HHD patients, a corresponding matched CHD patient was identified. Both treatment groups had the same mean age (50±13 years) at dialysis onset and were comparable with respect to the Khan comorbidity index, prevalence and duration of hypertension, smoking habits, history of myocardial infarction, stroke and peripheral vascular disease. In both groups, 50% of the patients were transplanted during the observation period. Results. HHD patients were hospitalized less often and tended to have fewer operations as compared with CHD patients. Survival was significantly longer in HHD as compared with CHD. Five, 10 and 20 year survival rates were 93 (n ¼ 55 patients at risk), 72 (41) and 34% (11) with HHD and 64 (38), 48 (26) and 23% (4) with CHD, respectively. This survival difference persisted after adjusting for predictors of mortality, i.e. age at onset of dialysis, year of start of dialysis therapy and Khan comorbidity index. Conclusions. HHD offers a cheap and valuable alternative to CHD, with no apparent disadvantages.

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“…Hence, the two studied populations were comparable with respect to the mentioned criteria. Furthermore, the comorbidity index [10] was comparable in both populations.…”

Section: Discussionmentioning

confidence: 76%

“…Comorbidity was scored using the Khan comorbidity index [10]. This index, derived from patient age and number of comorbidities, has been shown to be appropriate to express the prognostic impact of comorbidity on mortality risk in patients with ERSD [10].…”

Section: Methodsmentioning

confidence: 99%

Outcome of home haemodialysis patients: a case-cohort study

Saner¹,

Nitsch²,

Descoeudres³

et al. 2005

Nephrology Dialysis Transplantation

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“…When data allow, the patient population is split into four patient groups: adults by risk class (low, moderate and high risk) 1 and children. In addition, when data allow, the effect of different frequencies of home haemodialysis is assessed in relation to the frequency provided in hospitals.…”

Section: Aim Of the Reviewmentioning

confidence: 99%

“…Adults were classed as: low risk if they were less than 70 years of age and had no comorbid illness; medium risk if they were aged 70-80 years, or any age with one co-morbid illness, or less than 70 years with diabetes; or high risk if they were greater than 80 years of age, or any age with two co-morbidities, or any age with visceral cancer. 1 Generally, studies provided only the mean age and range of ages for each participant group as a whole and stated the percentage of each group with specific comorbid conditions, without identifying at-risk categories within each participant group separately throughout the study. However, six studies did provide outcome information in relation to specific risk groups.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of home versus hospital or satellite unit haemodialysis for people with end-stage renal failure

Mowatt

Vale

Perez

et al. 2003

Health Technol Assess

168

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK.We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NHS R&D HTA ProgrammeT he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS.The research reported in this monograph was commissioned by the HTA Programme on behalf of the National Institute for Clinical Excellence (NICE). Technology assessment reports are completed in a limited time to inform the appraisal and guidance development processes managed by NICE. The review brings together evidence on key aspects of the use of the technology concerned. However, appraisals and guidance produced by NICE are informed by a wide range of sources.The research reported in this monograph was funded as project number 01/46/01.The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme, NICE or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph seriesRe...

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“…Comorbidities at start of dialysis is also a strong predictor of mortality (47). It is an inevitable prognostic factor, and case-mix comorbidity has a profound influence on outcomes ofPD patients (48,49 (56)(57)(58)(59)(60) have also reported that patient survival is lesser and relative risk of mortality is greater in diabetic patients compared to that of non-diabetic PD patients and these differences has been attributed to the high prevalence of associated comorbidities in diabetic patients. (61) Report of the United…”

Section: Impact Of Comorbidities On Survival Of Pd Patientsmentioning

confidence: 99%

Impact of Malnutrition And Comorbities On Survival Of Peritoneal Dialysis Patients

Prasad¹,

Sinha²

2013

Indian Journal of Peritoneal Dialysis

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Protein energy malnutrition (PEM) and muscle wasting are present in a large proportion of patients with chronic kidney disease.Peritoneal dialysis (PD) is an established modality of renal replacement therapy worldwide. Comorbidities and malnutrition are common and higbly prevalent at the commencement ofPD therapy PEM and associated co-morbid conditions are amongst the several important factors affecting the survival of these patients. Major co morbidities such as cardiovascular disease and diabetes mellitos have strong influence on mortality. Comorbid conditions and clinical outcomes are closely associated. The associated co-morbidities in PD patients are not only important risk factors for increased morbidity and mortality, but also for the development of malnutrition. The prevalence of malnutrition in patients with comorbidities is high, compared with patients without comorbidities. Co-morbidities in PD patients can vary both in number and severity. Therefore the confounding effect of comorbidities should be quantified or stratified to assess its impact on various clinical outcomes including survival of these patients. Malnutrition and comorbidities either independently or in combination affect the survival of these patients. Patients with both malnutrition and comorbidities showed the worst survival. Nutritional assessment and nutritional counselling should be done periodically to improve the nutrition statos of PD patients. Associated comorbidities should be properly treated to improve clinical outcomes in these patients.

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Comparing outcomes in renal replacement therapy: How should we correct for case mix?

Cited by 23 publications

References 12 publications

Outcome of home haemodialysis patients: a case-cohort study

Outcome of home haemodialysis patients: a case-cohort study

Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of home versus hospital or satellite unit haemodialysis for people with end-stage renal failure

Impact of Malnutrition And Comorbities On Survival Of Peritoneal Dialysis Patients

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