Assisted PD versus IC HD

Clinical Journal of the American Society of Nephrology

Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis
Matthew J. Oliver*,†, Ahmed A. Al-Jaishi‡, Stephanie N. Dixon‡,§, Jeffrey Perl*,‖, Arsh K. Jain‡,¶, Susan D. Lavoie**, Danielle M. Nash‡, J. Michael Paterson††, Charmaine E. Lok§§, Robert R. Quinn‖‖,¶¶
+ Author Affiliations

*Department of Medicine, University of Toronto, Toronto, Ontario, Canada;
†Division of Nephrology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada;
‡Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
§Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada;
‖Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada;
¶Division of Nephrology, London Health Sciences Center, London, Ontario, Canada;
**Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada;
††Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
§§Division of Nephrology, University Health Network–Toronto General Hospital, Toronto, Ontario, Canada; and
‖‖Departments of Medicine and
¶¶Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Correspondence:
Dr. Matthew J. Oliver, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A239, Toronto, ON, Canada M4N3M5. Email: matthew.oliver@sunnybrook.ca
Abstract

Background and objectives Assisted peritoneal dialysis is a treatment option for individuals with barriers to self-care who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis.

Design, setting, participants, & measurements We conducted a multicenter, retrospective cohort study by linking a quality assurance dataset to administrative health data in Ontario, Canada. Subjects were accrued between January 1, 2004 and July 9, 2013. Individuals were grouped into assisted peritoneal dialysis (family or home care assisted) or in-center hemodialysis on the basis of their first outpatient dialysis modality. Inverse probability of treatment weighting using a propensity score was used to create a sample in which the baseline covariates were well balanced.

Results The study included 872 patients in the in–center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis were more likely to be hospitalized for dialysis-related reasons (admitted for 2.4 d/yr [95% confidence interval, 1.8 to 3.2] compared with 1.6 d/yr [95% confidence interval, 1.1 to 2.3] in the hemodialysis group; P=0.04). This difference was partly explained by more hospital days because of peritonitis. Modality switching was associated with high rates of hospital days per year.

Conclusions Assisted peritoneal dialysis was associated with similar rates of all-cause hospitalization compared with in-center hemodialysis. Patients on assisted peritoneal dialysis who experienced peritonitis and technique failure had high rates of hospitalization.

Copyright © 2016 by the American Society of Nephrology