Initiating dialysis with a VHA provider was associated with lower all-cause mortality (HR 0.87; 95% CI 0.83-0.93) but higher hospitalization rates (IRR 1.10; 95% CI 1.07-1.14) vs non-VHA providers.
Cohort (n=68,727)
Yes
Does initiating dialysis at a VHA provider compared to a non-VHA provider improve mortality and hospitalization rates in United States veterans with ESKD?
Among US veterans initiating dialysis, receiving care at a VHA facility is associated with lower mortality but higher hospitalization rates compared to non-VHA facilities.
Effect estimate: HR 0.87 (95% CI 0.83 to 0.93)
BACKGROUND AND OBJECTIVES: Veterans with ESKD initiate dialysis under the Veterans Health Administration (VHA), an integrated health system, or are outsourced to non-VHA providers. It is unknown whether outcomes differ according to their dialysis provider at initiation. We sought to evaluate the association between dialysis provider and mortality and hospitalization among United States veterans initiating dialysis. DESIGN, SETTING, PARTICIPANTS, 95% confidence interval, 1.07 to 1.14), but had lower all-cause mortality risk (adjusted hazard ratio, 0.87; 95% confidence interval, 0.83 to 0.93) in fully adjusted models. CONCLUSIONS: Veteran patients initiating dialysis with a VHA dialysis provider appear to have a lower mortality risk but higher hospitalization rates than veterans initiating dialysis at non-VHA dialysis units.
Streja et al. (2018) conducted a cohort in End-Stage Kidney Disease (ESKD) (n=68,727). VHA dialysis provider vs. non-VHA dialysis provider was evaluated on all-cause mortality and hospitalization rates (HR 0.87, 95% CI 0.83 to 0.93). Initiating dialysis with a VHA provider was associated with lower all-cause mortality (HR 0.87; 95% CI 0.83-0.93) but higher hospitalization rates (IRR 1.10; 95% CI 1.07-1.14) vs non-VHA providers.