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Institutional factors influencing regional differences in the 1‐year survival of dialysis patients
Author(s) -
Ogata Satoshi,
Nishi Shinichi,
Wakai Kenji,
Hanafusa Norio,
Iseki Kunitoshi,
Tsubakihara Yoshiharu,
Masakane Ikuto
Publication year - 2015
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12346
Subject(s) - medicine , hemodialysis , dialysis , intensive care medicine
There are regional differences in the survival of incident dialysis patients, but few studies have investigated the reasons. We assessed the effect of institutional factors on factors on survival (by both cross‐sectional assessment and after a 1‐year investigation) in a cohort of the J apanese S ociety for D ialysis T herapy ( JSDT ). We investigated 20 institutional factors from 3958 dialysis institution data of the 47 prefectures in J apan in 2005 and the JSDT database of 102,011 patients who commenced dialysis during 2004–2006. Univariate regression analysis between 20 factors and 1‐year survival rate, Kaplan–Meier method, log‐rank test, and C ox's proportional hazard model between the upper 24 and the lower 23 prefectures of the significant factors were carried out. The age‐adjusted 1‐year survival rate was 0.832 ± 0.027. Deaths occurred in 15.0% in 24 upper survival prefectures and 18.7% in 23 lower survival prefectures (P < 0.0001, unadjusted hazard ratio [ HR ] of death in lower survival prefectures: 1.26, 95% confidence interval [CI]: 1.17–1.40). A total of five factors among males were significantly correlated with 1‐year survival according to the univariate regression analysis. Among them, three factors (night‐time center/total dialysis center ratio [males: P < 0.0001, age, genders, and presence of diabetes adjusted HR: 0.88, 95% CI: 0.81–0.93], number of full‐time dialysis nurses [males: P = 0.0427, 0.94, 0.87–1.00], number of full‐time dialysis dietitians [males: P = 0.0084, 0.92, 0.85–0.98], respectively) were significant in K aplan– M eier analysis, log‐rank test, and the C ox's model. Institutional factors were closely related to the survival of incident dialysis patients, and regional differences in the survival may be explained, at least partly, by these factors.