Journal of Preventive Medicine and Public Health

Original Article

Regimen-related Mortality Risk in Patients Undergoing Peritoneal Dialysis Using Hypertonic Glucose Solution: A Retrospective Cohort Study: Chinakorn Sujimongkol, Cholatip Pongskul, Supannee Promthet; J Prev Med Public Health. 2018;51(4):205-212. Published online June 19, 2018; DOI: https://doi.org/10.3961/jpmph.18.066

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Objectives
The main purpose of this study was to quantify the risk of mortality linked to various regimens of hypertonic peritoneal dialysis (PD) solution.
Methods
A retrospective cohort study of patients using home-based PD was carried out. The prescribed regimen of glucose-based PD solution for all patients, determined on the basis of their individual conditions, was extracted from their medical chart records. The primary outcome was death. The treatment regimens were categorized into 3 groups according to the type of PD solution used: original PD (1.5% glucose), shuffle PD (1.5 and 2.5% glucose), and serialized PD (2.5 and 4.5% glucose). Multivariate analysis (using the Weibull model) was applied to comprehensively examine survival probabilities related to the explanatory variable, while adjusting for other potential confounders.
Results
Of 300 consecutive patients, 38% died over a median follow-up time of 30 months (interquartile range: 15-46 months). Multivariate analysis showed that a treatment regimen with continued higher-strength PD solution (serialized PD) resulted in a lower survival rate than when the conventional strength solution was used (adjusted hazard ratio, 2.6; 95% confidence interval, 1.6 to 4.6, p<0.01). Five interrelated risk factors (age, length of time on PD, hemoglobin levels, albumin levels, and oliguria) were significant predictors contributing to the outcome.
Conclusions
Frequent exposure to high levels of glucose PD solution significantly contributed to a 2-fold higher rate of death, especially when hypertonic glucose was prescribed continuously.

Summary

Citations

Citations to this article as recorded by

Associations of Glucometabolic Indices with Aortic Stiffness in Patients Undergoing Peritoneal Dialysis with and without Diabetes Mellitus
Chi-Chong Tang, Jen-Pi Tsai, Yi-Hsin Chen, Szu-Chun Hung, Yu-Li Lin, Bang-Gee Hsu
International Journal of Molecular Sciences.2023; 24(23): 17094. CrossRef

English Abstract

Impact of Health Insurance Type on the Quality of Hemodialysis Services: A Multilevel Analysis.: Jin Hee Jung, Soon Man Kwon, Kyoung Hoon Kim, Seon Kyoung Lee, Dong Sook Kim; J Prev Med Public Health. 2010;43(3):245-256.; DOI: https://doi.org/10.3961/jpmph.2010.43.3.245

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Abstract PDF

OBJECTIVES
This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate< or =55 g2/dL2 and albumin> or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.

Summary

Citations

Citations to this article as recorded by

A comparative study of epidemiological characteristics, treatment outcomes, and mortality among patients undergoing hemodialysis by health insurance types: data from the Korean Renal Data System
Kyeong Min Kim, Soyoung Lee, Jong Ho Shin, Mira Park
Kidney Research and Clinical Practice.2025; 44(1): 164. CrossRef
A Study of Effect on the Smoking Status using Multilevel Logistic Model
Ji Hye Lee, Tae-Young Heo
Korean Journal of Applied Statistics.2014; 27(1): 89. CrossRef
Multilevel Analysis on Factors Influencing Death and Transfer in Inpatient with Severe Injury
Young Eun Choi, Kang Suk Lee
Health Policy and Management.2013; 23(3): 233. CrossRef
Factors Affecting Diabetic Screening Behavior of Korean Adults: A Multilevel Analysis
Hyeongsu Kim, Minjung Lee, Haejoon Kim, Kunsei Lee, Sounghoon Chang, Vitna Kim, Jun Pyo Myong, Soyoun Jeon
Asian Nursing Research.2013; 7(2): 67. CrossRef

Comparative Study

Estimating the Cost Saving Due to the Effect of Kremezin in Delaying the Initiation of Dialysis Treatments among Patients with Chronic Renal Failure.: Hye Young Kang, Woohyun Cho, Sunmi Lee, Hyung Jong Kim, Ho Yong Lee, Tae Wook Woo; J Prev Med Public Health. 2006;39(2):149-158.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments. METHODS: We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and nonmedical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value. RESULTS: The present value of cumulative cost savings per patient with CRF from the societal perspective would be 18,555,000~29,410,000 Won or 72,104,000~112,523,000 Won if Kremezin delays the initiation of dialysis by 1 or 4 years. CONCLUSIONS: The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.; Summary

Original Article

Impacts of Implementing Case Payment System to Medical Aid Hemodialysis Patients on Dialysis Frequencies and Expenditure.: Sunhee Lee, Hanjoong Kim, Seungho Shin, Woohyun Cho, Hye Young Kang; J Prev Med Public Health. 2004;37(3):260-266.

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Abstract PDF: OBJECTIVES
To assess the impacts of implementing case payment system (CPS) to Medical Aid (MA) hemodialysis patients on the frequencies and expenditure of dialysis. METHODS: Fifty-eight clinics and 35 tertiary care hospitals were identified as having a minimum of 10 hemodialysis patients for each of the MA and Medical Insurance (MI) programs, who received hemodialysis from the same dialysis facilities for both periods of July 2001 and July 2002. From these facilities, a total of 2, 167 MA and 2, 928 MI patients were identified as the study subjects. Using electronic claims data, the changes in the total number of monthly treatments and charges for outpatient hemodialysis treatments for each patient after the introduction of the CPS were compared between the MA and MI patients. Multiple regression analyses were performed to examine the independent impact of the CPS on the utilization and expenditure of dialysis treatments among the MA patients. RESULTS: There was a significant decrease in the total charges for the hemodialysis treatments of the MA patients, 3.4% (p< 0.05), whereas a significant increase was observed for the MI patients, 2.5% (p< 0.05). For both the MA and MI patients, the frequency of the monthly hemodialysis treatments were significantly increased, 5.5 (from 12.1 to 12.7) and 7.8% (from 11.6 to 12.5), for the MA and MI patients, respectively. However, a multivariate regression analysis showed no significant difference in the changes in the total number of monthly hemodialysis treatments between the MA and MI patients after implementation of the CPS. Another regression model, regressing on the changes in the monthly claims of dialysis treatments, showed a significant negative coefficient for the MA ( (=-70725, p< 0.05). CONCLUSION: The significant decrease in the total charges for hemodialysis treatments among MA as compared to MI patients suggests that there was a cost reduction in the MA program following the introduction of the CPS.; Summary

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