Global differences in dialysis modality mix

The role of patient characteristics, macroeconomics and renal service indicators

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

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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).ResultsThe 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.

Original languageEnglish
Pages (from-to)1264-1275
Number of pages12
JournalNephrology Dialysis Transplantation
Volume28
Issue number5
DOIs
Publication statusPublished - May 2013

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Peritoneal Dialysis
Dialysis
Kidney
Confidence Intervals
Health Expenditures
Renal Dialysis
Linear Models
Gross Domestic Product
Delivery of Health Care
Costs and Cost Analysis
Diabetic Nephropathies
Population Characteristics
Chronic Kidney Failure
Economics
Organizations
Survival
Incidence

Keywords

  • dialysis
  • epidemiology
  • health policy
  • macroeconomics

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Van De Luijtgaarden, M. W. M., Jager, K. J., Stel, V. S., Kramer, A., Cusumano, A., Elliott, R. F., ... Caskey, F. J. (2013). Global differences in dialysis modality mix: The role of patient characteristics, macroeconomics and renal service indicators. Nephrology Dialysis Transplantation, 28(5), 1264-1275. https://doi.org/10.1093/ndt/gft053

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.

In: Nephrology Dialysis Transplantation, Vol. 28, No. 5, 05.2013, p. 1264-1275.

Research output: Contribution to journalArticle

Van De Luijtgaarden, MWM, Jager, KJ, Stel, VS, Kramer, A, Cusumano, A, Elliott, RF, Geue, C, MacLeod, AM, Stengel, B, Covic, A & Caskey, FJ 2013, 'Global differences in dialysis modality mix: The role of patient characteristics, macroeconomics and renal service indicators', Nephrology Dialysis Transplantation, vol. 28, no. 5, pp. 1264-1275. https://doi.org/10.1093/ndt/gft053
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. / Global differences in dialysis modality mix : The role of patient characteristics, macroeconomics and renal service indicators. In: Nephrology Dialysis Transplantation. 2013 ; Vol. 28, No. 5. pp. 1264-1275.
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abstract = "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).ResultsThe 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.",
keywords = "dialysis, epidemiology, health policy, macroeconomics",
author = "{Van De Luijtgaarden}, {Moniek W. M.} and Jager, {Kitty J.} and Stel, {Vianda S.} and Anneke Kramer and Ana Cusumano and Elliott, {Robert F.} and Claudia Geue and MacLeod, {Alison M.} and Benedicte Stengel and Adrian Covic and Caskey, {Fergus J.}",
note = "FUNDING The EVEREST study is supported by the ERA-EDTA QUality European STudies (QUEST) Initiative. The study received official endorsement from the ERA-EDTA and the International Society of Nephrology (ISN). ACKNOWLEDGEMENTS We are indebted to colleagues at each of the collaborating renal registries (listed in Appendix 1 in [27]) for their time, for providing the registry data and for assisting in the identification of suitable national experts. We also thank all the national experts (listed in Appendix 1 in [27]) for the considerable time and effort they have contributed to the study. Although these organizations and individuals have provided data for this study, the analyses, conclusions, opinions and statements expressed herein are those of the authors and do not necessarily reflect the opinions of collaborators.",
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T1 - Global differences in dialysis modality mix

T2 - The role of patient characteristics, macroeconomics and renal service indicators

AU - Van De Luijtgaarden, Moniek W. M.

AU - Jager, Kitty J.

AU - Stel, Vianda S.

AU - Kramer, Anneke

AU - Cusumano, Ana

AU - Elliott, Robert F.

AU - Geue, Claudia

AU - MacLeod, Alison M.

AU - Stengel, Benedicte

AU - Covic, Adrian

AU - Caskey, Fergus J.

N1 - FUNDING The EVEREST study is supported by the ERA-EDTA QUality European STudies (QUEST) Initiative. The study received official endorsement from the ERA-EDTA and the International Society of Nephrology (ISN). ACKNOWLEDGEMENTS We are indebted to colleagues at each of the collaborating renal registries (listed in Appendix 1 in [27]) for their time, for providing the registry data and for assisting in the identification of suitable national experts. We also thank all the national experts (listed in Appendix 1 in [27]) for the considerable time and effort they have contributed to the study. Although these organizations and individuals have provided data for this study, the analyses, conclusions, opinions and statements expressed herein are those of the authors and do not necessarily reflect the opinions of collaborators.

PY - 2013/5

Y1 - 2013/5

N2 - 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).ResultsThe 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.

AB - 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).ResultsThe 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.

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