SAT-294 The relationship between peritoneal dialysis mortality and the Chinese medical insurance

Abstract

There are two major medical insurance models in China: the Urban Basic Medical Insurance (UBMI) and the New Cooperative Medical Scheme (NCMS). We have observed that Chinese medical insurance type may affect the outcomes of patients treated with hemodialysis. The aim of the present study was to evaluate the association of the medical insurance type of patients undergoing peritoneal dialysis (PD) with their survival. We retrospectively analyzed the end-stage renal disease (ESRD) adult patients initiating PD between January 2008 and December 2016 in Zhejiang province, followed up through December 31, 2017. Patients had received continuous ambulatory PD for over 3 months, whom were divided into two groups according to their medical insurance type. Demographic, education level, clinical data, biochemical parameters and primary clinical outcomes including all-cause mortality, switch to hemodialysis and kidney transplant were analyzed. The survival rates were calculated by using the Kaplan-Meier method. A total of 8065 patients were enrolled, which is the largest cohort in China so far. There were 3523 patients (2090 males(59.3%)) with UBMI and 4542 (2317 males (51.0%)) with NCMS enrolled from 92 peritoneal dialysis units. Compared with UBMI, patients with NCMS were older (50 (IQR: 41-62) years old vs. 53 (IQR: 44-64)years old, P<0.001), had lower education level, smaller proportion of diabetic nephropathy and malignancy, more severe anemia, and more frequent hypoalbuminemia and hypocalcemia. The 1-, 3- and 5-year overall survival rates were 97.5%, 88.9%, and 81.5% in UBMI group, 95.9%, 85.9%, and 76.7% in NCMS group, respectively. Patients with NCMS showed higher all-cause mortality compared with UBMI (P<0.001). In multivariate Cox proportional hazards model, NCMS was independently associated with higher mortality (AHR=1.288; 95% CI 1.110,1.494). The medical insurance model was independently associated with PD patient survival, NCMS was associated with increased mortality among patients undergoing maintenance peritoneal dialysis in China.