title: Estimation of the Center Effect on Early Peritoneal Dialysis Failure: A Multilevel Modelling Approach.
abstract: ♦
  
  
  BACKGROUND
  This study was carried out to investigate the center effect on the risk of peritoneal dialysis (PD) failure within the first 6 months of therapy using a multilevel approach. ♦
  
  
  METHODS
  This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analyzed 5,406 incident patients starting PD between January 2008 and December 2012 in 128 PD centers. The end of the observation period was December 31, 2013. ♦
  
  
  RESULTS
  Of the 5,406 patients, 415 stopped PD within the first 6 months. There was a significant heterogeneity between centers (variance of the random effect: 0.10). Only 3% of the variance of the event of interest was attributable to differences between centers. At the individual level, only treatment before PD (odds ratio [OR]: 1.93 for hemodialysis and OR: 2.29 for renal transplantation) and underlying nephropathy (p < 0.01) were associated with early PD failure. At the center level, only center experience was associated (OR: 0.78) with the risk of PD failure. Center effect accounted for 52% of the disparities between centers. ♦
  
  
  CONCLUSIONS
  Center effect on early PD failure is significant. Center experience is associated with a lower risk of transfer to hemodialysis.
authors.affiliation: Néphrologie, CHU Caen, Caen, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Guillouët
authors.affiliation: RDPLF, Pontoise, France.
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Veniez
authors.affiliation: RDPLF, Pontoise, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Verger
authors.affiliation: Néphrologie, CHU Caen, Caen, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Béchade
authors.affiliation: Néphrologie, CHU Caen, Caen, France.
authors.forename: Maxence
authors.initials: M
authors.lastname: Ficheux
authors.affiliation: CHU Caen, Caen, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Uteza
authors.affiliation: Néphrologie, CHU Caen, Caen, France RDPLF, Pontoise, France lobbedez-t@chu-caen.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lobbedez
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D004868:Equipment Failure; D005260:Female; D005602:France; D006436:Hemodialysis Units, Hospital / Q000458:organization & administration*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure
keywords: Peritoneal dialysis; center effect; multilevel modelling