Experts recommend claims-based approach when studying PD-associated peritonitis
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A Medicare claims-based approach offers a “promising framework” for researchers studying peritoneal dialysis-associated peritonitis, according to data published in the American Journal of Kidney Diseases.
Further, researchers emphasized a need for consistent coding standards for peritonitis.
“The majority of epidemiologic information about PD-associated peritonitis has come from clinical or registry studies. While such studies offer clinical precision, they also reveal large inconsistencies in diagnostic criteria,” Eric W. Young, MD, from the Arbor Research Collaborative for Health in Michigan, and colleagues wrote.
In a retrospective cohort study, investigators explored the use of Medicare claims as a resource about PD-associated peritonitis to characterize peritonitis trends and determine its clinical risk factors.
Claims, eligibility, modality and demographic information were derived from U.S. Renal Data System standard analysis files between 2013 and 2017. All patients included in the sample received PD and were covered by Medicare fee-for-service insurance with paid claims for dialysis or hospital services. Researchers used a list of ICD-9 and ICD-10 diagnosis codes to identify peritonitis claims from the files, and any claims within a 30-day period were grouped into one peritonitis episode.
Researchers characterized peritonitis risk by year, age, sex, race, ethnicity, time with end-stage kidney disease, diagnosis and prior peritonitis episodes, then modeled patient-level risk factors using Poisson regression.
A total of 396,289 peritonitis claims yielded 70,271 peritonitis episodes. Researchers did not use one code significantly more than any other when recording peritonitis, but they were frequently identified by multiple grouped claims (mean claims per episode were 5.6). Codes revealed that 40% of episodes were exclusively outpatient, 9% were exclusively inpatient and 16% were unclear as to whether the episodes were peritonitis or catheter infections.
Researchers identified an overall peritonitis rate of 0.54 episodes per patient year, which declined to 0.35 when limited to episodes that only included claims from nephrologists or dialysis providers and excluded catheter codes.
Ultimately, the peritonitis rate declined 5% each year since end-stage kidney disease diagnosis and differed based on patient factors, race and previous peritonitis episodes. For example, rates were lower among older patients, and rates were higher with each additional prior episode.
“We find that the claims-based approach offers a promising framework for the study of PD-associated peritonitis. The approach yields plausible rates and reveals potentially important risk factors,” Young and colleagues wrote. “Our findings highlight the need for uniform coding standards and modernized diagnostic coding options. The method should be compared with existing clinical measurement systems employed by dialysis facilities. The approach has the potential to identify additional risk factors and important opportunities for practice improvements. Given the national scope of the data, the approach could contribute to a PD-associated peritonitis quality measurement system in the U.S.”
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