Dialysis in public and private hospitals in Queensland

Abstract

BACKGROUND: Clinical outcomes for patients treated in public and private hospitals may be different. AIM: The aim of the study was to compare the characteristics and outcomes of patients receiving dialysis at public and private hospitals in Queensland. METHODS: Incident adult dialysis patients in Queensland registered with the Australia and New Zealand Dialysis and Transplant Registry between 1999 and 2009 were classified by dialysis modality at either a public or private hospital. Outcomes were dialysis patient characteristics and survival. RESULTS: Three thousand, three hundred and ten patients commenced dialysis in public hospitals, 1939 haemodialysis (HD) and 1371 peritoneal dialysis (PD). Seven hundred and ninety-three patients commenced dialysis in private hospitals, 757 HD and 36 PD. Compared with public HD, private HD patients were older, had more coronary artery disease and less diabetes, and were more likely to live in an urban area. Public HD patients were more likely to be obese and referred late to a nephrologist. Nearly all indigenous patients were managed in public hospitals. Private patients were more likely to have an arteriovenous fistula or graft at first HD (P < 0.001) but not after excluding late referrals (P = 0.09). Public hospitals provided longer HD sessions and more HD hours per week for all age groups except 75+ years. Compared with public hospital HD, patient survival adjusted for multiple variables was comparable for private hospital HD (hazard ratio 1.20 (95% confidence interval 0.98–1.46, P = 0.07)) but worse for public PD (hazard ratio 1.14 (95% confidence interval 1.05–1.24, P = 0.002)). CONCLUSION: Private HD patients are older and less likely to be diabetic than public patients. Patient survival is worse for public PD than public HD.