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Titolo Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators
Autore Moniek W.M. van de Luijtgaarden1, Kitty J. Jager1, Vianda S. Stel1, Anneke Kramer1, Ana Cusumano2, Robert F. Elliott3, Claudia Geue4, Alison M. MacLeod5, Benedicte Stengel6,7, Adrian Covic8 and Fergus J. Caskey
Referenza Nephrol Dial Transplant 2013; doi: 10.1093/ndt/gft053

Background. An increase in the dialysis programme expenditure is expected in most countries given the continued rise in the number of people with end-stage renal disease (ESRD) globally. Since chronic peritoneal dialysis (PD) therapy is relatively less expensive compared with haemodialysis (HD) and because there is no survival difference between PD and HD, identifying factors associated with PD use is important.

Methods. Incidence counts for the years 2003–05 were available from 36 countries worldwide. We studied associations of population characteristics, macroeconomic factors and renal service indicators with the percentage of patients on PD at Day 91 after starting dialysis. With linear regression models, we obtained relative risks (RRs) with 95% confidence

intervals (CIs).

Results. The median percentage of incident patients on PD was 12% (interquartile range: 7–26%). Determinants independently associated with lower percentages of patients on PD were as follows: patients with diabetic kidney disease (per 5% increase) (RR 0.93; 95% CI 0.89–0.97), health expenditure as % gross domestic product (per 1% increase) (RR 0.93; 95% CI 0.87–0.98), private-for-profit share of HD facilities (per 1% increase) (RR 0.996; 95% CI 0.99–1.00; P = 0.04), costs of PD consumables relative to staffing (per 0.1 increase) (RR 0.97; 95% CI 0.95–0.99).

Conclusions. The factors associated with a lower percentage of patients on PD include higher diabetes prevalence, higher healthcare expenditures, larger share of private-for-profit centres and higher costs of PD consumables relative to staffing. Whether dialysis modality mix can be influenced by changing healthcare organization and funding requires additional studies.

Data 05.04.2013
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