ArticleBMJ open2013
Would increasing centre volumes improve patient outcomes in peritoneal dialysis? A registry-based cohort and Monte Carlo simulation study.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review of the impact of center volume in dialysis.BMC research notes · 2015Pooled it
- Research hotspots and development trends in volume management of peritoneal dialysis patients: a bibliometrics and visual analysis up to 2022.International urology and nephrology · 2024Article
- Excessive risk and poor outcome of hospital-acquired peritoneal dialysis-related peritonitis.Clinical kidney journal · 2022Article
- The impact of volume overload on technique failure in incident peritoneal dialysis patients.Clinical kidney journal · 2021Article
- Impact of pediatric cardiac surgery regionalization on health care utilization and mortality.Health services research · 2019Article
- Estimation of the Center Effect on Early Peritoneal Dialysis Failure: A Multilevel Modelling Approach.Peritoneal dialysis international : journal of the International Society for Peritoneal DialysisArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo estimate the association between centre volume and patient outcomes in peritoneal dialysis, explore robustness to residual confounding and predict the impact of policies to increase centre volumes.
designRegistry-based cohort study with probabilistic sensitivity analysis and Monte Carlo simulation of (hypothetical) intervention effects.
setting112 secondary-care centres in France.
participants9602 adult patients initiating peritoneal dialysis.
main outcome measuresTechnique failure (ie, permanent transfer to haemodialysis), renal transplantation and death while on peritoneal dialysis within 5 years of initiating treatment. Associations with underlying risk measured by cause-specific HRs (cs-HRs) and with cumulative incidence by subdistribution HRs (sd-HRs). Intervention effects measured by predicted mean change in cumulative incidences.
resultsHigher volume centres had more patients with diabetes and were more frequently academic centres or associative groupings of private physicians. Patients in higher volume centres had a reduced risk of technique failure (>60 patients vs 0-10 patients: adjusted cs-HR 0.46; 95% CI 0.43 to 0.69), with no changed risk of death or transplantation. Sensitivity analyses mitigated the cs-HRs without changing the findings. In higher volume centres, the cumulative incidence was reduced for technique failure (>60 patients vs 0-10 patients: adjusted sd-HR 0.49; 95% CI 0.29 to 0.85) but was increased for transplantation and death (>60 patients vs 0-10 patients: transplantation-adjusted sd-HR 1.53; 95% CI 1.04 to 2.24; death-adjusted sd-HR 1.28; 95% CI 1.00 to 1.63). The predicted reduction in cumulative incidence of technique failure was largest under a scenario of shifting all patients to the two highest volume centre groups (0.091 reduction) but lower for three more realistic interventions (around 0.06 reduction).
conclusionsPatients initiating peritoneal dialysis in high-volume centres had a considerably reduced risk of technique failure but simulations of interventions to increase exposure to high-volume centres yielded only modest improvements.
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