Comparing Mortality of Peritoneal and Hemodialysis Patients in an Era of Medicare Payment Reform
Dados Bibliográficos
BACKGROUND: Prior studies have shown peritoneal dialysis (PD) patients to have lower or equivalent mortality to patients who receive in-center hemodialysis (HD). Medicare's 2011 bundled dialysis prospective payment system encouraged expansion of home-based PD with unclear impacts on patient outcomes. This paper revisits the comparative risk of mortality between HD and PD among patients with incident end-stage kidney disease initiating dialysis in 2006-2013. RESEARCH DESIGN: We conducted a retrospective cohort study comparing 2-year all-cause mortality among patients with incident end-stage kidney disease initiating dialysis via HD and PD in 2006-2013, using data from the US Renal Data System and Medicare. Analysis was conducted using Cox proportional hazards models fit with inverse probability of treatment weighting that adjusted for measured patient demographic and clinical characteristics and dialysis market characteristics. RESULTS: Of the 449,652 patients starting dialysis between 2006 and 2013, the rate of PD use in the first 90 days increased from 9.3% of incident patients in 2006 to 14.2% in 2013. Crude 2-year mortality was 27.6% for patients dialyzing via HD and 16.7% for patients on PD. In adjusted models, there was no evidence of mortality differences between PD and HD before and after bundled payment (hazard ratio, 0.96; 95% confidence interval, 0.89-1.04; P=0.33). CONCLUSIONS: Overall mortality for HD and PD use was similar and mortality differences between modalities did not change before versus after the 2011 Medicare dialysis bundled payment, suggesting that increased use of home-based PD did not adversely impact patient outcomes
Confidence interval · Dialysis · End stage renal disease · Hazard ratio · Hemodialysis · Intensive care medicine · Mortality rate · Peritoneal dialysis · Proportional hazards model · Retrospective cohort study · Chronic Kidney Disease and Diabetes · Dialysis and Renal Disease Management · Emergency Medicine · Internal Medicine · Medicine · Renal Transplantation Outcomes and Treatments
Validating recommendations for coronary angiography following acute myocardial infarction in the elderly
Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity‐score matched samples
A New Equation to Estimate Glomerular Filtration Rate
Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies
| Velocidade de citação | historical |
|---|---|
| Altamente citado | Não |