title: Association of peritoneal dialysis clinic size with clinical outcomes.
abstract: OBJECTIVE
  Very few studies have addressed the relationship between number of peritoneal dialysis (PD) patients treated at a clinic (PD clinic size) and clinical outcomes. In a national prospective cohort study of incident PD patients (n = 236, from 26 clinics), we examined whether being treated at a larger PD clinic [>50 PD patients (n = 3 clinics) vs <or=50 PD patients (n = 23 clinics)] was associated with better patient outcomes, including fewer switches to hemodialysis, fewer cardiovascular events, lower cardiovascular mortality, and lower all-cause mortality.
  
  
  METHODS
  Multivariable Cox models were used to assess relative hazards (RHs) for modality switches, cardiovascular events, cardiovascular deaths, and all-cause deaths by PD clinic size. All models were adjusted for demographics, comorbidities, laboratory values, and clinic years in operation.
  
  
  RESULTS
  Being treated at a clinic with >50 patients was associated with fewer switches to hemodialysis (RH = 0.13, 95% CI 0.06 - 0.31) and fewer cardiovascular events (RH = 0.62, 95% CI 0.06 - 0.98). No associations of PD clinic size with cardiovascular or all-cause mortality were seen.
  
  
  CONCLUSIONS
  PD patients treated at clinics with greater numbers of PD patients may have better outcomes in terms of technique failure and cardiovascular morbidity. PD clinic size may act as a proxy of greater PD experience, more focus on the modality, and better PD practices at the clinic, resulting in better outcomes.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Fink
authors.forename: Fredric O
authors.initials: FO
authors.lastname: Finkelstein
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006276:Health Facility Size; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States