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Titolo Underutilization of peritoneal dialysis: the role of the nephrologist’s referral pattern
Autore Jay Hingwala1, Jeff Diamond2, Navdeep Tangri1,3,5, Joe Bueti1,3,4, Claudio Rigatto1,3,5, Manish M. Sood1,3,6, Mauro Verrelli1,3,6 and Paul Komenda1,3,5 - 1Department of Medicine, Section of Nephrology, University of Manitoba, Winnipeg, Canada, 2TR Labs, Infomagnetics Technologies, Winnipeg, Canada, 3Manitoba Renal Program, Winnipeg, Canada, 4Health Sciences Centre, Winnipeg, Canada, 5Seven Oaks General Hospital, Winnipeg, Canada and 6St. Boniface General Hospital, Winnipeg, Canada
Referenza Nephrol Dial Transplant 2012; doi: 10.1093/ndt/gfs323
Contenuto

Background. The incidence of end-stage renal disease is increasing, placing a tremendous burden on health care resources. Peritoneal dialysis (PD) is cheaper than hemodialysis and has many potential advantages and few contraindications as an initial modality selection. This study examined differences in patient PD attempt rates between nephrologists using technique survival and mortality as outcomes.

Methods. We performed a retrospective review of the Manitoba Renal Program databases from January 2004 to January 2010. Analysis of 630 patients who commenced dialysis and had demographic data available was performed. A genetic matching algorithm was used to balance potential differences between patient characteristics. Each nephrologist was then compared against their peers to calculate a PD attempt rate. The highest attempt rate group was compared with the lowest.

Results. When comparing PD attempt rates between groups, all the results were significant. PD technique survival at >90 days showed no significant differences (P = 0.42). Patient mortality at >90 days was also not significant when comparing groups (P = 0.14).

Conclusions. Our data suggest that when comparing the low- with high-attempt groups, the factors limiting PD utilization do not include on-site availability of PD, case mix, funding, patient location or reimbursement. Aggressive approaches of starting more patients on PD did not lead to lower technique survival or higher mortality rates. If the PD attempt rate was maximized, a significant amount of money and resources could be saved or directed toward helping a larger population without significant harm to patients.

Data 27.05.2013
 
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