Global differences in dialysis modality mix

the role of patient characteristics, macroeconomics and renal service indicators

van de Luijtgaarden, Moniek W.M.
Jager, Kitty J.
Stel, Vianda S.
Kramer, Anneke
Cusumano, Ana
Elliott, Robert F.
Geue, Claudia
MacLeod, Alison M.
Stengel, Benedicte
Covic, Adrian
Caskey, Fergus J.

¹ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
²Sociedad Latinoamericana de Nefrologia e Hipertensión, Latin America and Centro de Educación Médica e Investigaciones Clínicas University Institute, Buenos Aires, Argentina
³Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
⁴Health Economics & Health Technology Assessment Institute for Health & Wellbeing, Glasgow, UK
⁵Section of Population Health, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
⁶Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity, and Kidney Diseases Team, Villejuif, France
⁷Université Paris Sud 11, UMRS 1018, Villejuif F-94807, France
⁸Societatea Romana de Nefrologie and University of Medicine ‘Gr T Popa’, Iasi, Romania
⁹Richard Bright Renal Unit, Bristol, UK
¹⁰The School of Clinical Sciences, University of Bristol, Bristol, UK

Correspondence and offprint requests to: Moniek W.M. van de Luijtgaarden; Email: [email protected]

Received August 16, 2012

Accepted February 4, 2013

Nephrology Dialysis Transplantation 28(5):p 1264-1275, May 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.