Document Detail


Impact of global economic disparities on practices and outcomes of chronic peritoneal dialysis in children: insights from the International Pediatric Peritoneal Dialysis Network Registry.
MedLine Citation:
PMID:  22859840     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RESULTS: We observed close associations of GNI with the fraction of very young patients on dialysis, the presence and number of comorbidities, the prevalence of patients with unexplained causes of end-stage kidney disease, and the rate of culture-negative peritonitis. The prevalence of automated PD increased with GNI, but was 46% even in the lowest GNI stratum. The GNI stratum also affected the use of biocompatible peritoneal dialysis fluids, enteral tube feeding, calcium-free phosphate binders, active vitamin D analogs, and erythropoiesis-stimulating agents (ESAs). Patient mortality was strongly affected by GNI (hazard ratio per $10 000: 3.3; 95% confidence interval: 2.0 to 5.5) independently of young patient age and the number of comorbidities present. Patients from low-income countries tended to die more often from infections unrelated to CPD (5 of 9 vs 15 of 61, p = 0.1). The GNI was also a strong independent predictor of standardized height (p < 0.0001), adding to the impact of congenital renal disease, anuria, age at PD start, and dialysis vintage. Patients from the lower economic strata (GNI < $18 000) had higher serum parathyroid hormone (PTH) and lower serum calcium, and achieved lower hemoglobin concentrations. No impact of GNI was observed with regard to CPD technique survival or peritonitis incidence.
CONCLUSIONS: We conclude that CPD is practiced successfully, albeit with major regional variation related to economic differences, in children around the globe. The variations encompass the acceptance of very young patients and those with associated comorbidities to chronic dialysis programs, the use of automated PD and expensive drugs, and the diagnostic management of peritonitis. These variations in practice related to economic difference do not appear to affect PD technique survival; however, economic conditions seem to affect mortality on dialysis and standardized height, a marker of global child morbidity.
Authors:
Franz Schaefer; Dagmara Borzych-Duzalka; Marta Azocar; Reyner Loza Munarriz; Lale Sever; Nejat Aksu; Lorena Sànchez Barbosa; Yajaira Silva Galan; Hong Xu; Paula A Coccia; Attila Szabo; William Wong; Rosana Salim; Enrico Vidal; Stephen Pottoore; Bradley A Warady;
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  32     ISSN:  1718-4304     ISO Abbreviation:  Perit Dial Int     Publication Date:    2012 Jul-Aug
Date Detail:
Created Date:  2012-08-03     Completed Date:  2013-06-11     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  399-409     Citation Subset:  IM    
Affiliation:
Pediatric Nephrology Division, Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, Heidelberg, Germany. franz.schaefer@med.uni-heidelberg.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Comorbidity
Healthcare Disparities / economics*
Humans
Incidence
Infant
Kidney Failure, Chronic / epidemiology*,  mortality
Linear Models
Peritoneal Dialysis / economics,  statistics & numerical data*
Registries
Survival Rate
Investigator
Investigator/Affiliation:
L Alconcher / ; E Sojo / ; P A Coccia / ; A Suarez / ; P G Valles / ; R Salim / ; S A Salta / ; K van Hoeck / ; V Koch / ; J Feber / ; D A Geary / ; C White / ; M Valenzuela / ; J Villagra / ; F Cano / ; M A Contreras / ; A Vogel / ; P Zambrano / ; P Berrocal / ; K C Tse / ; H Xu / ; K Vondrak / ; K Rönnholm / ; J Harambat / ; B Ranchin / ; G Roussey / ; T Ulinski / ; M Fischbach / ; R Büscher / ; M Kemper / ; L Pape / ; F Schaefer / ; D Borzych / ; J Misselwitz / ; G Klaus / ; D Haffner / ; F Papachristou / ; A Szabo / ; A Bagga / ; M Kanitkar / ; E Verrina / ; A Edefonti / ; E Vidal / ; G Leozappa / ; D Landau / ; K H Paik / ; B Aoun / ; E Sahpazova / ; L Sànchez Barbosa / ; W Wong / ; J W Groothoff / ; Y Silva / ; R Loza Munarriz / ; D Borzych / ; D Drozdz / ; M Lipka / ; H Ziolkowska / ; M Sczepanska / ; O Brumariu / ; J Kari / ; H K Yap / ; G Ariceta / ; F Santos / ; N Besbas / ; S Bakkaloglu / ; I Bilge / ; E Serdaroglu / ; A Bal / ; L Rees / ; A R Watson / ; J Grünberg / ; L Greenbaum / ; A Neu / ; D Askenazi / ; M Ferris / ; H Patel / ; S Al-Akash / ; S Pottoore / ; V Dharnidharka / ; T Bunchman / ; A Chua / ; B A Warady / ; N McAfee / ; J Zaritsky / ; I S Ha /
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