Geographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort study

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dc.contributor.authorSood, Manish M.
dc.contributor.authorTangri, Navdeep
dc.contributor.authorHiebert, Brett
dc.contributor.authorKappel, Joanne
dc.contributor.authorDart, Allison
dc.contributor.authorLevin, Adeera
dc.contributor.authorManns, Braden
dc.contributor.authorMolzahn, Anita
dc.contributor.authorNaimark, David
dc.contributor.authorNessim, Sharon J.
dc.contributor.authorRigatto, Claudio
dc.contributor.authorSoroka, Steven D.
dc.contributor.authorZappitelli, Michael
dc.contributor.authorKomenda, Paul
dc.date.accessioned2014-06-25T17:20:16Z
dc.date.available2014-06-25T17:20:16Z
dc.date.issued2014
dc.description.abstractBackground Peritoneal dialysis is associated with similar survival and similar improvement in quality of life and is less costly compared with in-centre hemodialysis. We examined facility and geographic variation in the use of peritoneal dialysis in Canada. Methods We analyzed data from the Canadian Organ Replacement Register for the period January 2001 to December 2010. We identified patients for whom peritoneal dialysis was the primary modality at 90 days after initiation of dialysis. We used multilevel models to evaluate variation in use of peritoneal dialysis by facility and geographic region. Results We analyzed data for 31 778 incident dialysis patients at 56 facilities in 13 geographic regions across Canada. Use of peritoneal dialysis at 90 days varied considerably across geographic regions (range 19.8%–36.1%) and declined over time, from 28.8% in 2001 to 22.5% in 2010. After adjustment for case mix and facility-level quality indicators, 9.3% and 3.4% of the variability was attributable to facility and geographic factors, respectively. In adjusted models, there was a substantial difference between geographic regions with the lowest and highest peritoneal dialysis use (odds ratio for high use 1.51, 95% confidence interval [CI] 1.33–1.73 v. odds ratio for low use 0.69, 95% CI 0.60–0.79). Interpretation In Canada, substantial variability in the use of peritoneal dialysis attributable to facility and geographic region was not explained by differences in patient case mix. An opportunity exists to optimize use of this cost-effective therapy through changes in policy and standardization of criteria for initiation of peritoneal dialysis.en_US
dc.description.sponsorshipThis study was supported by the Canadian Institutes of Health Research and the Kidney Foundation of Canada. The study sponsors had no role in the design of the study, the collection, analysis or interpretation of data, the writing of the report or the decision to submit the article for publication.en_US
dc.identifier.citationSood, M.M., Tangri, N., Hiebert, B., et al. (2014). Geographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort study. CMAJ, 2(1), E36-E44.en_US
dc.identifier.doihttp://dx.doi.org/10.9778/cmajo.20130050
dc.identifier.urihttp://hdl.handle.net/1993/23652
dc.language.isoengen_US
dc.publisherCMAen_US
dc.rightsopen accessen_US
dc.titleGeographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort studyen_US
dc.typeArticleen_US
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