Impact of Modality Choice on Rates of Hospitalization in Patients Eligible for Both Peritoneal Dialysis and Hemodialysis

Abstract

♦ Background: Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality. Previous comparisons of peritoneal dialysis (PD) and hemodialysis (HD) have not been restricted to individuals who were eligible for both therapies. ♦ Methods: We conducted a multicenter prospective cohort study of people 18 years of age and older who were eligible for both PD and HD, and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs. Zero-inflated negative binomial models, adjusted for baseline patient characteristics, were used to examine the association between modality choice and rates of hospitalization. ♦ Results: The study enrolled 314 patients. A trend in the HD group toward higher rates of hospitalization, observed in the primary analysis, became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care. Cardiovascular disease, infectious complications, and elective surgery were the most common reasons for hospital admission; only 23% of hospital stays were directly related to complications of dialysis or kidney disease. ♦ Conclusions: Efforts to promote PD utilization are unlikely to result in increased rates of hospitalization, and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications.

Dialysis modality and survival: Done to death

“…In a more recent study, Quinn et al, in an effort to reduce bias, assessed the impact of dialysis modality on hospitalization rates of patients who were classified as eligible for both therapies in a multicenter prospective Canadian cohort. While no overall difference in hospitalization rates was found, there was a significant increase in hospitalization rates with HD when the population was further restricted to those initiating outpatient dialysis after at least 4 months of pre‐dialysis care . Of note, most hospital admissions (>75%) were unrelated to dialysis.…”

“…While no overall difference in hospitalization rates was found, there was a significant increase in hospitalization rates with HD when the population was further restricted to those initiating outpatient dialysis after at least 4 months of pre-dialysis care. 60 Of note, most hospital admissions (>75%) were unrelated to dialysis.…”

Emergency Department Use among Patients with CKD: A Population-Based Analysis

“…CKD affects approximately 10% of the adult population and is associated with increased morbidity and mortality (1)(2)(3)(4)(5). Prior studies have also observed high resource use among patients with CKD (6)(7)(8)(9). The majority of these studies have focused on either inpatient use or emergency department (ED) use among patients with ESRD (8,(10)(11)(12)(13).…”

“…Prior studies have also observed high resource use among patients with CKD (6)(7)(8)(9). The majority of these studies have focused on either inpatient use or emergency department (ED) use among patients with ESRD (8,(10)(11)(12)(13). There has been limited exploration of how patients with CKD use the ED and whether utilization is associated with disease severity.…”

Multiple-frequency bioimpedance devices for fluid management in people with chronic kidney disease receiving dialysis: a systematic review and economic evaluation

“…A number of studies were identified, suggesting that CV event-related hospitalisation rates account for ≈ 20% of all hospitalisations in dialysis cohorts. [108][109][110] The most relevant source of evidence to the UK RRT population reported that CV events made up 17.6% of the annual inpatient event rate in a cohort of 1226 UK HD patients. 110 This value was applied in the base case.…”