title: Impact of modality choice on rates of hospitalization in patients eligible for both peritoneal dialysis and hemodialysis.
abstract: BACKGROUND
  Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality. Previous comparisons of peritoneal dialysis (PD) and hemodialysis (HD) have not been restricted to individuals who were eligible for both therapies. ♢
  
  
  METHODS
  We conducted a multicenter prospective cohort study of people 18 years of age and older who were eligible for both PD and HD, and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs. Zero-inflated negative binomial models, adjusted for baseline patient characteristics, were used to examine the association between modality choice and rates of hospitalization. ♢
  
  
  RESULTS
  The study enrolled 314 patients. A trend in the HD group toward higher rates of hospitalization, observed in the primary analysis, became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care. Cardiovascular disease, infectious complications, and elective surgery were the most common reasons for hospital admission; only 23% of hospital stays were directly related to complications of dialysis or kidney disease. ♢
  
  
  CONCLUSIONS
  Efforts to promote PD utilization are unlikely to result in increased rates of hospitalization, and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications.
authors: Faculties of Medicine and Community Health Sciences1 and of Medicine,2 University of Calgary, Calgary, Alberta;
authors: Robert R
authors: RR
authors: Quinn
authors: Pietro
authors: P
authors: Ravani
authors: Xin
authors: X
authors: Zhang
authors: Amit X
authors: AX
authors: Garg
authors: Peter G
authors: PG
authors: Blake
authors: Peter C
authors: PC
authors: Austin
authors: James M
authors: JM
authors: Zacharias
authors: John F
authors: JF
authors: Johnson
authors: Sanjay
authors: S
authors: Pandeya
authors: Mauro
authors: M
authors: Verrelli
authors: Matthew J
authors: MJ
authors: Oliver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D006435:Renal Dialysis; D055815:Young Adult
keywords: Hemodialysis; hospitalization