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

doi:10.1093/ndt/gft053

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 journal › Article › peer-review

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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.

Original language	English
Pages (from-to)	1264-1275
Number of pages	12
Journal	Nephrology Dialysis Transplantation
Volume	28
Issue number	5
DOIs	https://doi.org/10.1093/ndt/gft053
Publication status	Published - May 2013

Bibliographical 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.

Keywords

dialysis
epidemiology
health policy
macroeconomics

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Van De Luijtgaarden, M. W. M., Jager, K. J., Stel, V. S., Kramer, A., Cusumano, A., Elliott, R. F., Geue, C., MacLeod, A. M., Stengel, B., Covic, A., & 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

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

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title = "Global differences in dialysis modality mix: The role of patient characteristics, macroeconomics and renal service indicators",

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.",

year = "2013",

month = may,

doi = "10.1093/ndt/gft053",

language = "English",

volume = "28",

pages = "1264--1275",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "OXFORD UNIV PRESS",

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TY - JOUR

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.

KW - dialysis

KW - epidemiology

KW - health policy

KW - macroeconomics

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Global differences in dialysis modality mix: The role of patient characteristics, macroeconomics and renal service indicators

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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