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Variation in the Level of eGFR at Dialysis Initiation across Dialysis Facilities and Geographic Regions
- Source :
- Clinical Journal of the American Society of Nephrology. 9:1747-1756
- Publication Year :
- 2014
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2014.
-
Abstract
- Background and objectives The relative influence of facilities and regions on the timing of dialysis initiation remains unknown. The purpose of the study is to determine the variation in eGFR at dialysis initiation across dialysis facilities and geographic regions in Canada after accounting for patient-level factors (case mix). Design, setting, participants, & measurements In total, 33,263 dialysis patients with an eGFR measure at dialysis initiation between January of 2001 and December of 2010 representing 63 dialysis facilities and 14 geographic regions were included in the study. Multilevel models and intraclass correlation coefficients were used to evaluate the variation in timing of dialysis initiation by eGFR at the patient, facility, and geographic levels. Results The proportion initiating dialysis with an eGFR≥10.5 ml/min per 1.73 m 2 was 35.3%, varying from 20.1% to 57.2% across geographic regions and from 10% to 67% across facilities. In an unadjusted, intercept-only linear model, 90.7%, 6.6%, and 2.7% of the explained variability were attributable to patient, facility, and geography, respectively. After adjustment for patient and facility factors, 96.9% of the explained variability was attributable to patient case mix, 3.1% was attributable to the facility, and 0.0% was attributable to the geographic region. These findings were consistent when the eGFR was categorized as a binary variable (≥10.5 ml/min per 1.73 m 2 ) or in an analysis limited to patients with >3 months of predialysis care. Conclusions Patient characteristics accounted for the majority of the explained variation regarding the eGFR at the initiation of dialysis. There was a small amount of variation at the facility level and no variation among geographic regions that was independent of patient- and facility-level factors.
- Subjects :
- Male
Canada
medicine.medical_specialty
Time Factors
Multivariate analysis
Epidemiology
Intraclass correlation
medicine.medical_treatment
Kidney
Critical Care and Intensive Care Medicine
Time-to-Treatment
Case mix index
Renal Dialysis
Residence Characteristics
medicine
Humans
Registries
Healthcare Disparities
Intensive care medicine
Dialysis
Transplantation
Chi-Square Distribution
business.industry
Multilevel model
Editorials
Middle Aged
Explained variation
Treatment Outcome
Nephrology
Multivariate Analysis
Linear Models
Geographic regions
Kidney Failure, Chronic
Female
Health Facilities
business
Chi-squared distribution
Glomerular Filtration Rate
Demography
Subjects
Details
- ISSN :
- 15559041
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Clinical Journal of the American Society of Nephrology
- Accession number :
- edsair.doi.dedup.....42f349a664619bfcbbbf3d75c8d47a74