June 23, 1997
Media Contact: Nancy Volkers
Researchers from the Johns Hopkins Children's Center report that treatment centers seeing a higher percentage of pediatric patients are more likely to use a less invasive method of dialysis for children with end-stage renal disease (ESRD), while centers seeing fewer children tend to prescribe a more time-intensive and restrictive dialysis method.
The study was published in the June issue of Archives of Pediatrics & Adolescent Medicine.
Susan L. Furth, M.D., and colleagues at Hopkins examined data on 1,256 pediatric patients with end-stage renal disease (ESRD). Each patient underwent either peritoneal dialysis or hemodialysis at a single treatment facility for most of 1990. All patients were tracked through the Medicare registry.
Children treated at facilities with more than 10 percent pediatric patients were 60 percent more likely to be treated with peritoneal dialysis, and those at facilities with 1-5 percent pediatric patients were 50 percent more likely to receive peritoneal dialysis, than were patients at facilities where children comprised less than one percent of patients.
These associations persisted, even when differences in patient age, race, family income, education, cause and duration of ESRD, or facility characteristics (hospital-based versus independent, for-profit versus not-for-profit status) were taken into account.
"There are large differences in the dialysis treatment choices made for children with renal failure," says Furth. "These differences depend on the treating facilities' experience with children."
Because reimbursement for both types of dialysis is equal under Medicare, it is unlikely that ability to pay was a factor in treatment choice, she adds.
Hemodialysis uses a filter connected to a machine to clean the blood. Most patients on hemodialysis must visit their treatment center several times each week, for hours at a stretch. Home hemodialysis requires training and space for the equipment.
Peritoneal dialysis uses the lining of the abdomen to filter blood. A cleansing solution (dialysate) is introduced into the abdomen via a catheter. Fluid, wastes, and chemicals pass from tiny blood vessels in the peritoneal membrane into the dialysate. After several hours, the dialysate is drained from the abdomen and replaced with new solution. Peritoneal dialysis can be done in the home, requiring home delivery of supplies and monthly clinic visits for supervision.
"Peritoneal dialysis is widely considered the treatment of choice for children with kidney failure who require dialysis," says Furth. "Several studies have shown that children treated with peritoneal dialysis have better coping skills and less depression than those on hemodialysis." Children on peritoneal dialysis also can attend school regularly, she adds.
Furth and colleagues also found that hospital-based and not-for-profit facilities had more pediatric experience than their for-profit counterparts.
In a study published in April 1997, Furth and other researchers found that black children with ESRD were nearly 2.5 times more likely to receive hemodialysis than peritoneal dialysis, compared with white children with ESRD.
"As health care delivery changes," says Furth, "we need to examine whether these differences in treatment choices translate to different outcomes for children with kidney disease."
Other authors of the study are Neil R. Powe, M.D., M.P.H., M.B.A.; Wenke Hwang, M.S.; Alicia M. Neu, M.D.; and Barbara A. Fivush, M.D.
The Johns Hopkins Children's Center is the children's hospital of The Johns Hopkins Medical Institutions. Maryland's most comprehensive acute-care hospital for children, the center, with its 177-bed hospital and more than 40 divisions and services, treats some 8,000 inpatients annually, with more than 64,000 outpatient visits.