Abstract
BackgroundSocioeconomic characteristics may affect the outcomes of patients treated with peritoneal dialysis (PD). There are two major medical insurances in China: the New Cooperative Medical Scheme (NCMS), mainly for rural residents, and the Urban Employees’ Medical Insurance (UEMI). The aim of the present study was to assess the effect of medical insurance type on survival of patient undergoing PD.MethodThis was a prospective study in adult patients who underwent PD at the Wuhan No.1 Hospital between January 2008 and December 2013. Patients had received continuous ambulatory PD for >3 months. Patients were divided according to their medical insurance. Demographic and socioeconomic data, biochemical parameters and primary clinical outcomes including all-cause mortality, switch to hemodialysis and kidney transplantation were analyzed.ResultThere were 415 patients with UEMI and 149 with NCMS. Compared with UEMI, patients with NCMS were younger, and had shorter dialysis duration, smaller proportion of diabetic nephropathy, more severe anemia, and more frequent hyperphosphatemia and hyperuricemia. Total Kt/V, creatinine clearance and residual renal function were not different. There was no difference in technique survival (P > 0.05) between the two groups, but rural patients showed lower overall survival (P < 0.05). Multivariate analysis showed that NCMS was independently associated with lower survival (RR = 1.49; 95% CI = 1.04-2.15).ConclusionsMedical insurance model is independently associated with PD patient survival.
Highlights
Socioeconomic characteristics may affect the outcomes of patients treated with peritoneal dialysis (PD)
Medical insurance model is independently associated with PD patient survival
The primary outcome of the present study was to assess the association between insurance type and survival in PD patients, and results showed that PD patients with New Cooperative Medical Scheme (NCMS) had a lower survival compared with PD patients with Urban Employees’ Medical Insurance (UEMI)
Summary
Socioeconomic characteristics may affect the outcomes of patients treated with peritoneal dialysis (PD). The association between patient characteristics and clinical outcomes in patients treated with peritoneal dialysis (PD) are complex and multifactorial [1,2,3]. Previous studies have shown that characteristics such as lower income, lower education level and being female were associated with higher mortality in PD patients [4,5,6]. Dialysis patients living in rural areas have higher mortality compared with urban residents [7]. The patient volume of the PD center, education level and the distance from the residence to the hospital are associated with peritonitis, the most important complication of PD [8,9]. Racial and insurance disparity may affect the choice of treatment for patients
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