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Comparison of patient hospitalization in chronic peritoneal dialysis and hemodialysis: a pediatric multicenter study
E Verrina1, F Perfumo, G Zacchello
1Italian Registry of Pediatric CPD, Italy.
Insights
Pediatric patients on chronic peritoneal dialysis (CPD) experienced fewer hospitalizations than those on center hemodialysis (HD). However, younger children on CPD had more dialysis-related complications, impacting overall hospitalization duration.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Modalities
Background:
- Chronic peritoneal dialysis (CPD) and center hemodialysis (HD) are key treatments for pediatric end-stage renal disease.
- Patient age and dialysis modality significantly influence treatment outcomes and healthcare utilization.
- Understanding hospitalization patterns is crucial for optimizing pediatric dialysis care.
Purpose of the Study:
- To compare patient hospitalization rates between pediatric chronic peritoneal dialysis (CPD) and center hemodialysis (HD) patients.
- To analyze hospitalization causes, including modality-related complications, across different age groups and dialysis types.
- To evaluate the impact of dialysis modality on healthcare resource utilization in children with kidney failure.
Main Methods:
- A retrospective study comparing 207 pediatric patients (< or = 15 years) on CPD (127) versus HD (80) from 1989-1994.
- Hospitalization rates calculated as hospital days per patient-month, analyzed overall and by year.
- Patients stratified into three groups: younger CPD (<5 years), older CPD (5-15 years), and HD (5-15 years).
Main Results:
- Overall hospitalization rates were significantly lower for both CPD patient groups compared to HD patients.
- Hospitalization for dialysis-related complications was higher in younger CPD patients (<5 years).
- No significant difference in hospitalization for dialysis-related complications was observed between age-matched CPD and HD patients (5-15 years).
Conclusions:
- Chronic peritoneal dialysis is associated with lower overall hospitalization rates in pediatric patients compared to center hemodialysis.
- Younger children on CPD may experience a higher burden of dialysis-related complications, warranting careful monitoring.
- Dialysis modality choice in pediatric kidney disease requires consideration of age-specific risks and benefits.
Abstract:
Patient hospitalization was compared in 207 pediatric patients (age < or = 15 years at the start of dialysis) on chronic peritoneal dialysis (CPD) (127 patients) or center hemodialysis (HD) (80 patients), treated in 17 dialysis centers during the period 1989 to 1994, and followed up for at least three months. The hospitalization rate was expressed as hospital days per patient-month, and was calculated on the overall period of treatment and separately for the first and second year. Since the age at start of dialysis markedly differed between CPD (8.2 +/- 4.7 years) and HD (11.2 +/- 2.9 years) patients (with no HD patient younger than five years), results are separately presented in three patient groups: CPD patients aged < 5 years (A); CPD patients aged five to 15 years (B); HD patients (C). The duration of hospitalization was subdivided according to the following different causes: routine (monitoring of dialysis adequacy), complications of the modality, patient primary renal disease, and other causes. The results are presented in Table 1. A statistically significant difference in total days hospitalized was found between each of the two groups of CPD patients and the HD patients; the results for hospitalization for dialysis-related complications were higher in the group of younger children on CPD, while the difference between the two age-matched groups of patients on CPD and HD was not significant.
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