Technique Failure and Center Size in a Large Cohort of Peritoneal Dialysis Patients in a Defined Geographic Area

Abstract

Background Hemodialysis (HD) and peritoneal dialysis (PD) are both viable options for renal replacement therapy. Technique failure has been shown to be a major problem in PD therapy. Objective To examine the relationship between center size and PD technique failure. Setting ESRD Network #1 (NW1). Design Retrospective review of NW1 database. Patients and Methods 5003 incident PD patients between 2001 and 2005 in 105 PD units were included. Patients were grouped into 2 based on center size: group A, patients in units with ≤25 patients, and group B, patients in units with >25 patients. Outcome measures were analyzed for the first and second years of PD therapy. Patients were censored at transplantation, transfer to HD, or death. Outcome Measures Technique failure and mortality reported as death in Standard Information Management Systems (SIMS) database (NW1 data system). Results Technique failure rates were significantly higher in group A for year 1 (odds ratio: 1.36, p = 0.005) and for year 2 (odds ratio: 1.35, p = 0.03). Mortality rates were not statistically different between the 2 groups. Conclusion Technique failure was higher in units with ≤25 patients than in units with >25 patients. There was no difference in mortality between the 2 groups. The majority of patients in NW1 receive care in small units.