Technique failure and center size in a large cohort of peritoneal dialysis patients in a defined geographic area

Abstract

Background: Hemodialysis (HD) and peritoneal dialysis (PD) are both viable options for renal replacement therapy. Technique failure has been shown to be a major problem in PD therapy.

Objective: To examine the relationship between center size and PD technique failure.

Setting: ESRD Network #1 (NW1).

Design: Retrospective review of NW1 database.

Patients and methods: 5003 incident PD patients between 2001 and 2005 in 105 PD units were included. Patients were grouped into 2 based on center size: group A, patients in units with <or=25 patients, and group B, patients in units with >25 patients. Outcome measures were analyzed for the first and second years of PD therapy. Patients were censored at transplantation, transfer to HD, or death.

Outcome measures: Technique failure and mortality reported as death in Standard Information Management Systems (SIMS) database (NW1 data system).

Results: Technique failure rates were significantly higher in group A for year 1 (odds ratio: 1.36, p = 0.005) and for year 2 (odds ratio: 1.35, p = 0.03). Mortality rates were not statistically different between the 2 groups.

Conclusion: Technique failure was higher in units with <or=25 patients than in units with >25 patients. There was no difference in mortality between the 2 groups. The majority of patients in NW1 receive care in small units.