PT  - JOURNAL ARTICLE
AU  - Manish M Sood
AU  - Navdeep Tangri
AU  - Brett Hiebert
AU  - Joanne Kappel
AU  - Allison Dart
AU  - Adeera Levin
AU  - Braden Manns
AU  - Anita Molzahn
AU  - David Naimark
AU  - Sharon J Nessim
AU  - Claudio Rigatto
AU  - Steven D Soroka
AU  - Michael Zappitelli
AU  - Paul Komenda
AU  - on behalf of the Canadian Kidney Knowledge Translation
AU  - Generation Network
TI  - Geographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort study
AID  - 10.9778/cmajo.20130050
DP  - 2014 Jan 22
TA  - CMAJ Open
PG  - E36--E44
VI  - 2
IP  - 1
4099  - http://www.cmajopen.ca/content/2/1/E36.short
4100  - http://www.cmajopen.ca/content/2/1/E36.full
AB  - Background Peritoneal dialysis is associated with similar survival and similar improvement in quality of life and is less costly compared with in-centre hemodialysis. We examined facility and geographic variation in the use of peritoneal dialysis in Canada. Methods We analyzed data from the Canadian Organ Replacement Register for the period January 2001 to December 2010. We identified patients for whom peritoneal dialysis was the primary modality at 90 days after initiation of dialysis. We used multilevel models to evaluate variation in use of peritoneal dialysis by facility and geographic region. Results We analyzed data for 31 778 incident dialysis patients at 56 facilities in 13 geographic regions across Canada. Use of peritoneal dialysis at 90 days varied considerably across geographic regions (range 19.8%–36.1%) and declined over time, from 28.8% in 2001 to 22.5% in 2010. After adjustment for case mix and facility-level quality indicators, 9.3% and 3.4% of the variability was attributable to facility and geographic factors, respectively. In adjusted models, there was a substantial difference between geographic regions with the lowest and highest peritoneal dialysis use (odds ratio for high use 1.51, 95% confidence interval [CI] 1.33–1.73 v. odds ratio for low use 0.69, 95% CI 0.60–0.79). Interpretation In Canada, substantial variability in the use of peritoneal dialysis attributable to facility and geographic region was not explained by differences in patient case mix. An opportunity exists to optimize use of this cost-effective therapy through changes in policy and standardization of criteria for initiation of peritoneal dialysis.