目的:腹膜透析(PD)相关性腹膜炎的发生和后果限制了其在肾衰竭人群中的应用。对大量临床人群的研究可能会增强我们对腹膜炎的了解。为了促进这些研究,我们开发了一种使用Medicare索赔数据测量腹膜炎发生率的方法,以表征腹膜炎趋势并确定其临床风险因素。
方法:PD相关腹膜炎的回顾性队列研究。
方法:美国肾脏数据系统标准分析文件用于索赔,资格,模态,和人口统计信息。样本包括在2013年至2017年期间接受PD治疗的患者,这些患者接受了Medicare按服务收费(FFS)保险,并已支付透析或医院服务索赔。
未经证实:腹膜炎风险以年份为特征,年龄,性别,种族,种族,恢复肾脏替代疗法,肾衰竭的原因,和先前的腹膜炎发作。
结果:主要结局是腹膜炎,使用ICD-9和ICD-10诊断代码识别。紧密间隔的腹膜炎报告(30天)汇总为1次腹膜炎发作。
方法:使用泊松回归对腹膜炎患者水平的危险因素进行建模。
结果:我们从396,289例腹膜炎报告中确定了70,271例腹膜炎发作。尽管使用了各种代码来记录腹膜炎的发作,没有一个主要使用。腹膜炎发作通常通过多个汇总的索赔来识别,每次发作的平均和中位数分别为5.6和2。我们发现40%的发作完全是门诊发作,9%完全住院,16%完全基于无法明确区分腹膜炎和导管感染/炎症的编码(“导管编码”)。总腹膜炎发生率为每患者年0.54次(EPPY)。排除导管编码后的比率为0.45EPPY,仅限于仅包括肾脏科医师或透析提供者索赔的发作时的比率为0.35EPPY。腹膜炎的发病率每年下降5%,并因患者的年龄等因素而异(较高年龄的发病率较低),种族(黑色>白色>亚洲),和先前的腹膜炎发作(每次发作的发生率更高)。
结论:编码异质性表明缺乏标准化。仅基于导管代码的发作可能代表假阳性。腹膜炎发作未根据症状或微生物数据进行验证。
结论:PD相关腹膜炎的发生率随时间下降,在老年患者中更低。基于索赔的方法为PD相关腹膜炎的研究提供了一个有希望的框架。
The occurrence and consequences of peritoneal dialysis (PD)-associated peritonitis limit its use in populations with kidney failure. Studies of large clinical populations may enhance our understanding of peritonitis. To facilitate these studies we developed an approach to measuring peritonitis rates using Medicare claims data to characterize peritonitis trends and identify its clinical risk factors.
Retrospective cohort study of PD-associated peritonitis.
US Renal Data System standard analysis files were used for claims, eligibility, modality, and demographic information. The sample consisted of patients receiving PD treated at some time between 2013 and 2017 who were covered by Medicare fee-for-service (FFS) insurance with paid claims for dialysis or hospital services.
Peritonitis risk was characterized by year, age, sex, race, ethnicity, vintage of kidney replacement therapy, cause of kidney failure, and prior peritonitis episodes.
The major outcome was peritonitis, identified using ICD-9 and ICD-10 diagnosis codes. Closely spaced peritonitis claims (30 days) were aggregated into 1 peritonitis episode.
Patient-level risk factors for peritonitis were modeled using Poisson regression.
We identified 70,271 peritonitis episodes from 396,289 peritonitis claims. Although various codes were used to record an episode of peritonitis, none was used predominantly. Peritonitis episodes were often identified by multiple aggregated claims, with the mean and median claims per episode being 5.6 and 2, respectively. We found 40% of episodes were exclusively outpatient, 9% exclusively inpatient, and 16% were exclusively based on codes that do not clearly distinguish peritonitis from catheter infections/inflammation (\"catheter codes\"). The overall peritonitis rate was 0.54 episodes per patient-year (EPPY). The rate was 0.45 EPPY after excluding catheter codes and 0.35 EPPY when limited to episodes that only included claims from nephrologists or dialysis providers. The peritonitis rate declined by 5%/year and varied by patient factors including age (lower rates at higher ages), race (Black > White>Asian), and prior peritonitis episodes (higher rate with each prior episode).
Coding heterogeneity indicates a lack of standardization. Episodes based exclusively on catheter codes could represent false positives. Peritonitis episodes were not validated against symptoms or microbiologic data.
PD-associated peritonitis rates decline over time and were lower among older patients. A claims-based approach offers a promising framework for the study of PD-associated peritonitis.