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Dialysis Case Volume Associated With In-Hospital Mortality in Maintenance Dialysis Patients
Shintaro Mandai1, Hidehiko Sato1, Soichiro Iimori1
1Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Kidney International Reports
|May 5, 2018
Summary
Higher dialysis case volume (DCV) in hospitals is linked to better survival for patients on maintenance dialysis. Focusing on hospitals with greater DCV may improve patient outcomes and reduce in-hospital deaths.
Area of Science:
- Nephrology
- Healthcare Management
- Public Health
Background:
- Large hospital volume (HV) is often associated with improved patient outcomes across various medical conditions.
- The impact of hospital volume on outcomes for patients undergoing maintenance dialysis requires further clarification.
Purpose of the Study:
- To investigate the association between hospital volume (HV) and dialysis case volume (DCV) and in-hospital mortality among maintenance dialysis patients.
- To determine if higher DCV is independently associated with reduced mortality in this patient population.
Main Methods:
- Utilized data from Japan's Diagnosis Procedure Combination database (2012-2014).
- Included 382,689 admissions of maintenance dialysis patients (age >20).
- Assessed in-hospital all-cause mortality using multivariable logistic regression across quartiles of HV and DCV.
Main Results:
- Overall in-hospital mortality was 5.5% (21,182 deaths).
- While unadjusted analyses showed lower mortality with higher HV and DCV, only DCV remained significant after multivariable adjustment.
- Increased DCV demonstrated a dose-response relationship with reduced in-hospital mortality, independent of patient and admission characteristics.
Conclusions:
- Dialysis case volume (DCV) is a significant predictor of in-hospital mortality in maintenance dialysis patients.
- Higher DCV is associated with improved survival outcomes.
- Selective patient referral to hospitals with high DCV may be a strategy to enhance care quality and patient prognosis.
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