Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis.

Adult Aged Australia Female Hemodialysis, Home / statistics & numerical data Humans Kidney Failure, Chronic / therapy Male Middle Aged New Zealand Peritoneal Dialysis / statistics & numerical data Registries / statistics & numerical data
center effects home dialysis home hemodialysis peritoneal dialysis practice patterns

Journal

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
ISSN: 1460-2385
Titre abrégé: Nephrol Dial Transplant
Pays: England
ID NLM: 8706402

Informations de publication

Date de publication:
01 11 2020
Historique:
received: 28 10 2019
accepted: 09 12 2019
pubmed: 8 2 2020
medline: 9 3 2021
entrez: 8 2 2020
Statut: ppublish

Résumé

Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.

Sections du résumé

BACKGROUND
Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis.
METHODS
The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect.
RESULTS
Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics.
CONCLUSION
Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.

Identifiants

DOI: 10.1093/ndt/gfaa002 PMID: 32031636
pubmed: 32031636
pii: 5730196
doi: 10.1093/ndt/gfaa002
doi:

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1938-1949

Commentaires et corrections

Type : CommentIn

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Auteurs

Isabelle Ethier (I)

Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.

Yeoungjee Cho (Y)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.
Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.

Carmel Hawley (C)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.
Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.
Translational Research Institute, Brisbane, QLD, Australia.

Elaine M Pascoe (EM)

Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.
School of Medicine, University of Queensland, Brisbane, QLD, Australia.

Matthew A Roberts (MA)

Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.

David Semple (D)

Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.
School of Medicine, University of Auckland, Auckland, New Zealand.

Annie-Claire Nadeau-Fredette (AC)

Division of Nephrology, Hôpital Maisonneuve-Rosemont and Research Center, Université de Montréal, Montreal, Canada.

Matthew P Sypek (MP)

Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.

Andrea Viecelli (A)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.

Scott Campbell (S)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.

Carolyn van Eps (C)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.

Nicole M Isbel (NM)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.

David W Johnson (DW)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.
Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.
Translational Research Institute, Brisbane, QLD, Australia.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Effect of patient- and center-level...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Effect of patient- and center-level...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Effect of patient- and center-level...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services de santé communautaires › Hémodialyse à domicile › Effect of patient- and center-level...
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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie chronique › Insuffisance rénale chronique › Défaillance rénale chronique › Effect of patient- and center-level...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Effect of patient- and center-level...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Nouvelle-Zélande › Effect of patient- and center-level...
questionsmedicales.fr › Thérapeutique › Détoxication par sorption › Dialyse rénale › Dialyse péritonéale › Effect of patient- and center-level...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Effect of patient- and center-level...