title: Effect of center practices on the choice of the first dialysis modality for children and young adults.
abstract: Peritoneal dialysis (PD) remains the modality of choice in children, but there is no clear evidence to support a better outcome in children treated with PD. We aimed to assess factors that have an impact on the choice of dialysis modality in children and young adults in France and sought to determine the roles of medical factors and center practices.
  
  
  
  We included all patients aged <20 years at the start of renal replacement therapy (RRT), recorded in the French RRT Registry between 2002 and 2013. Hierarchical logistic regression models were used to study the association between the patient/center characteristics and the probability of receiving PD as the first dialysis modality.
  
  
  
  We included 806 patients starting RRT in 177 centers, 23 of which were specialized pediatric centers. Six hundred and one patients (74.6 %) started with hemodialysis (HD), whereas 205 (25.4 %) started with PD. A greater probability of PD was found in younger children, whereas starting the treatment in an emergency setting was associated with a low use of PD. We found a significant variability among centers that accounted for 43 % of the total variability. The probability of PD was higher in adult centers and was proportional to the rate of PD in the center.
  
  
  
  Center practices are a major factor in the choice of dialysis modality. This raises concerns about patient and family choices and to what extent doctors may influence the final decision. Further pediatric studies focusing on children's and parents' wishes are needed to provide care as close as possible to patients' and families' expectations.
authors.affiliation: Pediatric Nephrology Unit, Robert Debré Hospital APHP, 48 bld Serurier, 75019, Paris, France. julien.hogan@aphp.fr.|REIN Registry, Agence de la biomédecine, Saint-Denis, La Plaine, France. julien.hogan@aphp.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Hogan
authors.affiliation: Pediatric Nephrology Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Ranchin
authors.affiliation: Pediatric Nephrology Unit, Arnaud de Villeneuve Hospital, Montpellier, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Fila
authors.affiliation: Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Harambat
authors.affiliation: Pediatric Nephrology Unit, Necker Hospital, Paris, France.
authors.forename: Saoussen
authors.initials: S
authors.lastname: Krid
authors.affiliation: Pediatric Nephrology Unit, Hôpital d'Enfants Brabois, Nancy, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vrillon
authors.affiliation: Pediatric Nephrology Unit, Nantes University Hospital, Nantes, France.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Roussey
authors.affiliation: Pediatric Nephrology Unit, Hautepierre University Hospital, Strasbourg, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.affiliation: REIN Registry, Agence de la biomédecine, Saint-Denis, La Plaine, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D005602:France / Q000453:epidemiology; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000628:therapy; D008297:Male; D010372:Pediatrics; D010530:Peritoneal Dialysis / Q000379:methods* / Q000706:statistics & numerical data; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Children; Dialysis modality; Epidemiology; Hemodialysis; Peritoneal dialysis