Effect of renal center characteristics on mortality and technique failure on peritoneal dialysis

Background. Recent studies report decreased mortality in patients on perito neal dialysis (PD) over time, suggesting that advances in PD have resulted in improved patient outcomes. Our investigation sought to assess the effect of renal center characteristics on mortality and technique failure (TF) ra tes. Methods. Covariates of interest included center-specific cumulative number of PD patients treated, percentage of patients who initiated dialysis on PD , and academic status. Using data obtained from the Canadian Organ Replacem ent Register, the 17.900 patients who received PD during the 1981 to 1997 p eriod were studied. Mortality and TF rate ratios (RR) were estimated using Poisson regression, adjusting for age, gender, race, primary renal diagnosi s, province, follow-up time, and type of PD. Results. As the cumulative number of PD patients treated increased, covaria te-adjusted mortality significantly decreased (P < 0.05): a weaker yet sign ificant association was observed between number of PD patients treated and TF As the percentage of patients initiating dialysis on PD increased, TF ra tes decreased significantly. No association was observed between center aca demic status and PD mortality or TF rates. Conclusions. These results imply that a center's experience with and degree of specialization toward PD impact strongly on PD outcomes. One hypothesis is that a center's propensity to exploit technical and non-technical advan ces in PD increases directly with these variables. It is also possible that , through experience. centers become more adept at identifying appropriate patients to receive PD. More detailed research is required to evaluate thes e hypotheses.