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.

Keywords: Hemodialysis; hospitalization.

Figure 1 —

Primary reason for hospital admission, by initial outpatient dialysis treatment modality. Hospitalizations were classified based on the primary reason for admission: related to dialysis therapy, complications of kidney disease unrelated to dialysis therapy, or unrelated to kidney disease or dialysis therapy. In patients treated with peritoneal dialysis (PD) and hemodialysis (HD), most hospitalizations were unrelated to kidney disease or dialysis therapy. We observed no significant differences by modality in the proportion of admissions that fell into each category.