Hospital type and clinical outcomes in peritoneal dialysis: Findings from the PDTAP study

BackgroundThere are inequalities in resource allocation and services across peritoneal dialysis (PD) centers in China. This study aimed to explore the association between hospital type (university-affiliated vs. non-university-affiliated hospitals) and clinical outcomes in PD patients.MethodsData from the Peritoneal Dialysis Telemedicine-assisted Platform cohort was analyzed. The primary outcome was all-cause mortality, while secondary outcomes included hemodialysis transfer and first-episode PD-related peritonitis. Univariable and multivariable Fine-Gray models were used to calculate subdistribution hazard ratios (SHRs). Propensity-score matched analyses and sensitivity analyses restricted to incident patients were also performed.ResultsA total of 7416 PD patients were enrolled (June 2016 to April 2019), with a median follow-up of 29.0 months. University-affiliated hospitals' patients (n = 4806) were younger, had better nutritional status, and higher socio-economic status than those in non-university-affiliated hospitals (n = 2610). University-affiliated hospitals exhibited a lower risk for all-cause mortality (SHR: 0.72, 95% confidence interval (CI): 0.61-0.85, p < 0.001), higher hemodialysis transfer (SHR: 1.31, 95% CI: 1.08-1.60, p < 0.01), but no association with first-episode peritonitis in multivariable analyses. After propensity-score matching, university-affiliated hospitals were still associated with lower all-cause mortality (SHR: 0.74, 95% CI: 0.61-0.91, p < 0.01) and a higher risk of hemodialysis transfer (SHR: 1.52, 95% CI: 1.19-1.94, p < 0.01). Comparable results for all-cause mortality and first-episode peritonitis also found in incident patients.ConclusionIn China, PD patients in university-affiliated hospitals had lower mortality but a higher risk of hemodialysis transfer. Further studies are needed to understand these findings and inform future practices and resource allocations.