TY - JOUR
T1 - Impact of disease severity and hematocrit level on reuse-associated mortality
AU - Ebben, James P.
AU - Dalleska, Fred
AU - Ma, Jennie Z.
AU - Everson, Susan E.
AU - Constantini, Edward G.
AU - Collins, Allan J.
N1 - Funding Information:
Supported in part by unrestricted grants from the Minneapolis Medical Research Foundation, Minneapolis, MN; and Minntech Corporation (Plymouth, MN).
PY - 2000
Y1 - 2000
N2 - Prior studies on reuse-associated mortality have presented conflicting results and included few adjustments for disease severity or hematocrit levels. To evaluate the impact of patient and provider characteristics on reuse-associated mortality, we developed a period-prevalent model with a 6- month entry period. Five cohorts of Medicare hemodialysis patients surviving from July 1 through December 31 of the entry year (1991, 50,985 patients; 1992, 63,081 patients; 1993, 76,018 patients; 1994, 82,899 patients; 1995, 91,761 patients) were followed up for the next year. Using a basic Cox regression survival model (M-1) including age, sex, race, renal diagnosis, prior end-stage renal disease time, unit age, unit size, water treatment, dialysate, and germicide, results were compared with those using a more inclusive model (M-4) adding dialyzer type (conventional or high efficiency/high flux), unit designation (hospital based or freestanding), unit profit status, comorbidity, disease severity, and hematocrit. The previous association of for-profit units with increased mortality was not present after 1994. Whereas the M-1 analysis showed better survival in reuse units after 1991, the more complete M-4 analysis showed no difference in the risk for mortality between reuse and no-reuse units. We conclude that mortality rates in the United States from 1991 to 1995, when adjusted comprehensively for patient and unit characteristics, were not different in units that practiced reuse and those that did not. (C) 2000 National Kidney Foundation, Inc.
AB - Prior studies on reuse-associated mortality have presented conflicting results and included few adjustments for disease severity or hematocrit levels. To evaluate the impact of patient and provider characteristics on reuse-associated mortality, we developed a period-prevalent model with a 6- month entry period. Five cohorts of Medicare hemodialysis patients surviving from July 1 through December 31 of the entry year (1991, 50,985 patients; 1992, 63,081 patients; 1993, 76,018 patients; 1994, 82,899 patients; 1995, 91,761 patients) were followed up for the next year. Using a basic Cox regression survival model (M-1) including age, sex, race, renal diagnosis, prior end-stage renal disease time, unit age, unit size, water treatment, dialysate, and germicide, results were compared with those using a more inclusive model (M-4) adding dialyzer type (conventional or high efficiency/high flux), unit designation (hospital based or freestanding), unit profit status, comorbidity, disease severity, and hematocrit. The previous association of for-profit units with increased mortality was not present after 1994. Whereas the M-1 analysis showed better survival in reuse units after 1991, the more complete M-4 analysis showed no difference in the risk for mortality between reuse and no-reuse units. We conclude that mortality rates in the United States from 1991 to 1995, when adjusted comprehensively for patient and unit characteristics, were not different in units that practiced reuse and those that did not. (C) 2000 National Kidney Foundation, Inc.
KW - Comorbidity
KW - Diseas e severity
KW - Germicide
KW - Hematocrit
KW - Hemodialysis
KW - Mortality
KW - Outcomes
KW - Reuse
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U2 - 10.1016/S0272-6386(00)70333-7
DO - 10.1016/S0272-6386(00)70333-7
M3 - Article
C2 - 10676723
AN - SCOPUS:0033974160
SN - 0272-6386
VL - 35
SP - 244
EP - 249
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -