Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis.

Autor:	Ethier I; Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia., Cho Y; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.; Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia., Hawley C; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.; Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.; Translational Research Institute, Brisbane, QLD, Australia., Pascoe EM; Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.; School of Medicine, University of Queensland, Brisbane, QLD, Australia., Roberts MA; Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia., Semple D; Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.; School of Medicine, University of Auckland, Auckland, New Zealand., Nadeau-Fredette AC; Division of Nephrology, Hôpital Maisonneuve-Rosemont and Research Center, Université de Montréal, Montreal, Canada., Sypek MP; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia., Viecelli A; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.; Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia., Campbell S; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia., van Eps C; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia., Isbel NM; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.; Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia., Johnson DW; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.; Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.; Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia.; Translational Research Institute, Brisbane, QLD, Australia.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2020 Nov 01; Vol. 35 (11), pp. 1938-1949.
DOI:	10.1093/ndt/gfaa002
Abstrakt:	Background: Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. Methods: The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. Results: Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. Conclusion: Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand. (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
Databáze:	MEDLINE
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