title: Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study.
abstract: BACKGROUND
  The likelihood of peritoneal dialysis (PD) utilization following a PD catheter insertion attempt is poorly described. We explored the risk factors for PD nonuse, focusing on the method of PD catheter implantation.
  
  
  METHODS
  This population-based retrospective cohort study employed Ontario administrative health data to identify 3886 predialysis adults who had an incident PD catheter implantation between 2002 and 2010. The impact of the method of catheter implantation including open-surgical (open, n = 1884), surgical-laparoscopic (laparoscopic, n = 1154), nephrology-percutaneous (nephrology, n = 498) and radiology-percutaneous (radiology, n = 350) on rates of PD utilization (defined as four consecutive weeks of PD) was examined.
  
  
  RESULTS
  Eighty-three percent of study patients received PD. After adjustment, relative to patients with openly inserted catheters, PD utilization was greater for those with nephrology-inserted catheters [adjusted hazard ratio (aHR) 1.59, 95% confidence interval (CI) 1.29-1.95] and similar for radiology-inserted catheters [aHR 1.16, 95% CI 0.94-1.43] or laparoscopic-inserted catheters [aHR 0.97 (95% CI 0.86-1.09)]. Among PD nonusers, death occurred in 10% of the open group, 6% of the laparoscopic group, 27% of the radiology group and in fewer than 3% of the nephrology group. Sixty-nine percent received hemodialysis in the open group, 63% in the laparoscopic group, 61% in the radiology group and 88% in the nephrology group. Those remaining predialysis comprised 12% of the open group, 22% of the laparoscopic group, 11% of the radiology group and <3% of the nephrology group.
  
  
  CONCLUSIONS
  Nephrology insertion resulted in lower overall rates of PD nonuse, particularly due to death or remaining predialysis. Greater use may be related to insertion timing, technique or greater commitment on the part of nephrologists to the success of PD.
authors.affiliation: Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
authors.affiliation: Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada Ontario Renal Network, Toronto, Ontario, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pierratos
authors.affiliation: Ontario Renal Network, Toronto, Ontario, Canada.
authors.forename: Gokulan
authors.initials: G
authors.lastname: Kandasamy
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Brendan B
authors.initials: BB
authors.lastname: McCormick
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
authors.affiliation: Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Arsh K
authors.initials: AK
authors.lastname: Jain
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Anjie
authors.initials: A
authors.lastname: Huang
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Division of Nephrology, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada Division of Nephrology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002404:Catheterization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D009864:Ontario / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055815:Young Adult
keywords: peritoneal dialysis; peritoneal dialysis access; peritoneal dialysis catheter insertion; peritoneal dialysis utilization; survival