Elani Streja1,2, Csaba Pal Kovesdy3,4, Melissa Soohoo1, Yoshitsugu Obi1, Connie M Rhee1,2, Christina Park1, Joline L T Chen2, Tracy Nakata1, Danh V Nguyen5, Alpesh N Amin5, Steven J Jacobsen6, John J Sim7, Kamyar Kalantar-Zadeh8,2. 1. Harold Simmons Program in Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension and. 2. Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California. 3. Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee. 4. Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; and. 5. Department of Medicine, University of California, Irvine, Orange, California; and. 6. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California. 7. Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. 8. Harold Simmons Program in Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension and kkz@uci.edu.
Abstract
BACKGROUND AND OBJECTIVES: Veterans with ESKD initiate dialysis under the Veterans Health Administration (VHA), an integrated health system, or are outsourced to non-VHA providers. It is unknown whether outcomes differ according to their dialysis provider at initiation. We sought to evaluate the association between dialysis provider and mortality and hospitalization among United States veterans initiating dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 68,727 United States veterans who initiated dialysis in 2007-2014, we examined the association of dialysis provider (VHA versus non-VHA) at initiation with mortality and hospitalization rates in the first 12 months post-initiation. Associations were examined across adjusted models, accounting for demographics and comorbidities. RESULTS: Patients were 72±11 years, 5% were women, 24% were black, and 10% (n=7584) initiated at VHA dialysis centers. VHA dialysis center patients were younger, more likely to be black, had fewer cardiovascular comorbidities, and lower eGFR at dialysis initiation. VHA provider patients were more likely to be hospitalized in the first 12 months (adjusted incidence rate ratio, 1.10; 95% confidence interval, 1.07 to 1.14), but had lower all-cause mortality risk (adjusted hazard ratio, 0.87; 95% confidence interval, 0.83 to 0.93) in fully adjusted models. CONCLUSIONS: Veteran patients initiating dialysis with a VHA dialysis provider appear to have a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at non-VHA dialysis units.
BACKGROUND AND OBJECTIVES: Veterans with ESKD initiate dialysis under the Veterans Health Administration (VHA), an integrated health system, or are outsourced to non-VHA providers. It is unknown whether outcomes differ according to their dialysis provider at initiation. We sought to evaluate the association between dialysis provider and mortality and hospitalization among United States veterans initiating dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 68,727 United States veterans who initiated dialysis in 2007-2014, we examined the association of dialysis provider (VHA versus non-VHA) at initiation with mortality and hospitalization rates in the first 12 months post-initiation. Associations were examined across adjusted models, accounting for demographics and comorbidities. RESULTS:Patients were 72±11 years, 5% were women, 24% were black, and 10% (n=7584) initiated at VHA dialysis centers. VHA dialysis center patients were younger, more likely to be black, had fewer cardiovascular comorbidities, and lower eGFR at dialysis initiation. VHA provider patients were more likely to be hospitalized in the first 12 months (adjusted incidence rate ratio, 1.10; 95% confidence interval, 1.07 to 1.14), but had lower all-cause mortality risk (adjusted hazard ratio, 0.87; 95% confidence interval, 0.83 to 0.93) in fully adjusted models. CONCLUSIONS: Veteran patients initiating dialysis with a VHA dialysis provider appear to have a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at non-VHA dialysis units.
Authors: Sudhakar V Nuti; Li Qin; John S Rumsfeld; Joseph S Ross; Frederick A Masoudi; Sharon-Lise T Normand; Karthik Murugiah; Susannah M Bernheim; Lisa G Suter; Harlan M Krumholz Journal: JAMA Date: 2016-02-09 Impact factor: 56.272
Authors: Michael J Fischer; Kevin T Stroupe; James S Kaufman; Ann M O'Hare; Margaret M Browning; Zhiping Huo; Denise M Hynes Journal: Am J Manag Care Date: 2010-02-01 Impact factor: 2.229
Authors: Kamyar Kalantar-Zadeh; Csaba P Kovesdy; Elani Streja; Connie M Rhee; Melissa Soohoo; Joline L T Chen; Miklos Z Molnar; Yoshitsugu Obi; Daniel Gillen; Danh V Nguyen; Keith C Norris; John J Sim; Steve S Jacobsen Journal: Nephrol Dial Transplant Date: 2017-04-01 Impact factor: 5.992
Authors: Ann M O'Hare; Andy I Choi; W John Boscardin; Walter L Clinton; Ilan Zawadzki; Paul L Hebert; Manjula Kurella Tamura; Leslie Taylor; Eric B Larson Journal: Arch Intern Med Date: 2011-10-10
Authors: Kevin T Harley; Elani Streja; Connie M Rhee; Miklos Z Molnar; Csaba P Kovesdy; Alpesh N Amin; Kamyar Kalantar-Zadeh Journal: J Am Soc Nephrol Date: 2013-08-08 Impact factor: 10.121
Authors: Virginia Wang; Cynthia J Coffman; Karen M Stechuchak; Theodore S Z Berkowitz; Paul L Hebert; David Edelman; Ann M O'Hare; Susan T Crowley; Hollis J Weidenbacher; Matthew L Maciejewski Journal: J Am Soc Nephrol Date: 2018-12-07 Impact factor: 10.121
Authors: Virginia Wang; Shailender Swaminathan; Emily A Corneau; Matthew L Maciejewski; Amal N Trivedi; Ann M O'Hare; Vincent Mor Journal: Clin J Am Soc Nephrol Date: 2020-09-22 Impact factor: 8.237
Authors: Winn Cashion; Walid F Gellad; Florentina E Sileanu; Maria K Mor; Michael J Fine; Jennifer Hale; Daniel E Hall; Shari Rogal; Galen Switzer; Mohan Ramkumar; Virginia Wang; Douglas A Bronson; Mark Wilson; William Gunnar; Steven D Weisbord Journal: Clin J Am Soc Nephrol Date: 2021-02-18 Impact factor: 8.237
Authors: Michael J Fischer; Elani Streja; Jui-Ting Hsiung; Susan T Crowley; Csaba P Kovesdy; Kamyar Kalantar-Zadeh; Wissam M Kourany Journal: Clin Kidney J Date: 2021-06-25