BACKGROUND: Previous studies investigating hospitalizations in dialysis patients have focused primarily on patient-centered factors. We analyzed the impact of hospital and dialysis unit characteristics on pediatric dialysis patients' hospitalizations for access-related complications (ARCs). METHODS: This cross-sectional study involved 102 hemodialysis (HD) and 163 peritoneal dialysis (PD) patients. Data between July 2017 and July 2018 were analyzed. RESULTS: Children's hospitals (CHs) had more pediatric nephrologists and longer PD experience (years) than general hospitals (GHs) (p = 0.026 and p = 0.023, respectively). A total of 53% of automated PD (APD) and 6% of continuous ambulatory PD (CAPD) patients were in CHs (p < 0.001). Ninety-three percent of APD and 69% of CAPD patients were treated in pediatric-specific PD units (p = 0.001). CHs had a higher prevalence in providing hemodiafiltration (HDF) than GHs (83% vs. 30%). Ninety-seven percent of HDF vs. 66% for conventional HD (cHD) patients, and 94% of patients with arteriovenous fistula (AVF) vs. 70% of those with central venous catheters (CVC), were dialyzed in pediatric-specific HD units (p = 0.001 and p = 0.016, respectively). Eighty patients (51 PD and 29 HD) had 135 (84 PD, 51 HD) hospitalizations. CAPD was an independent risk factor for hospitalizations for infectious ARCs (I-ARCs) (p = 0.009), and a health center's PD experience negatively correlated with CAPD patient hospitalizations for I-ARCs (p = 0.041). cHD and dialyzing in combined HD units significantly increased hospitalization risk for non-infectious (NI-)ARCs (p = 0.044 and p = 0.017, respectively). CONCLUSIONS: CHs and pediatric-specific dialysis units have higher prevalence of APD and HDF use. Hospitalizations for I-ARCs in CAPD are lower in centers with longer PD experience, and pediatric HD units are associated with fewer hospitalizations due to NI-ARCs. A higher resolution version of the Graphical abstract is available as Supplementary information.

Department of Pediatric Nephrology Center for Pediatric and Adolescent Medicine Heidelberg Germany

Department of Pediatric Nephrology Centro Materno Infantil Do Norte CHP Porto Portugal

Department of Pediatric Nephrology Country Hautepierre CHU Strasbourg France

Department of Pediatric Nephrology Eskişehir City Training and Research Hospital Eskişehir Turkey

Department of Pediatric Nephrology Evelina London Children's Hospital London UK

Department of Pediatric Nephrology Faculty of Medicine Ankara University Ankara Turkey

Department of Pediatric Nephrology Faculty of Medicine Çukurova University Adana Turkey

Department of Pediatric Nephrology Faculty of Medicine Erciyes University Kayseri Turkey

Department of Pediatric Nephrology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Department of Pediatric Nephrology Gazi University Faculty of Medicine Beşevler Ankara Turkey 06500

Department of Pediatric Nephrology Great Ormond Street Hospital for Children London UK

Department of Pediatric Nephrology Instytut Centrum Zdrowia Matki Poland

Department of Pediatric Nephrology Medical School of Aristotle University Thessaloniki Greece

Department of Pediatric Nephrology University Hospital Motol Prague Czech Republic

Department of Pediatric Nephrology UO Di Nefrologia E Dialisi Ospedale Pediatrico Bambino Gesu IRCCS Rome Italy

Department of Pediatric Nephrology Vilnius University Hospital Vilnius Lithuania

Department of Pediatrics Nephrology and Hypertension Medical University of Gdansk Gdansk Poland

See more in PubMed

Rinaldi S, Sera F, Verrina E, Edefonti A, Gianoglio B, Perfumo F, Sorino P, Zacchello G, Cutaia I, Lavoratti G, Leozappa G, Pecoraro C, Rizzoni G, Italian Registry of Pediatric Chronic Peritoneal Dialysis (2004) Chronic peritoneal dialysis catheters in children: a fifteen-year experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Perit Dial Int 24:481–486 PubMed DOI

Borzych-Duzalka D, Shroff R, Ariceta G, Yap YC, Paglialonga F, Xu H, Kang HG, Thumfart J, Aysun KB, Stefanidis CJ, Fila M, Sever L, Vondrak K, Szabo AJ, Szczepanska M, Ranchin B, Holtta T, Zaloszyc A, Bilge I, Warady BA, Schaefer F, Schmitt CP (2019) Vascular access choice, complications, and outcomes in children on maintenance hemodialysis: findings from the international pediatric hemodialysis network (IPHN) registry. Am J Kidney Dis 74:193–202 PubMed DOI

McClellan WM, Soucie JM, Flanders WD (1998) Mortality in end-stage renal disease is associated with facility-to-facility differences in adequacy of hemodialysis. J Am Soc Nephrol 9:1940–1947 PubMed DOI

Rodriguez RA, Sen S, Mehta K, Moody-Ayers S, Bacchetti P, O’Hare AM (2007) Geography matters: relationships among urban residential segregation, dialysis facilities, and patient outcomes. Ann Intern Med 146:493 PubMed DOI

Fink JC, Blahut SA, Briglia AE, Gardner JF, Light PD (2001) Effect of center-versus patient-specific factors on variations in dialysis adequacy. J Am Soc Nephrol 12:164 PubMed DOI

Brooks JM, Irwin CP, Hunsicker LG, Flanigan MJ, Chrischilles EA, Pendergast JF (2006) Effect of dialysis center profit-status on patient survival: a comparison of risk-adjustment and instrumental variable approaches. Health Serv Res 41:2267–2289 PubMed DOI PMC

Henning P, Tomlinson L, Rigden SP, Haycock GB, Chantler C (1988) Long term outcome of treatment of end-stage renal failure. Arch Dis Child 63:35–40 PubMed DOI PMC

Chand DH, Swartz S, Tuchman S, Valentini RP, Somers MJ (2017) Dialysis in children and adolescents: the pediatric nephrology perspective. Am J Kidney Dis 69:278–286 PubMed DOI

Molnar AO, Moist L, Klarenbach S, Lafrance JP, Kim SJ, Tennankore K, Perl J, Kappel J, Terner M, Gill J, Sood MM (2018) Hospitalizations in dialysis patients in Canada: a national cohort study. Can J Kidney Health Dis 2054358118780372.  https://doi.org/10.1177/2054358118780372

Gupta R, Skootsky SA, Kahn KL, Chen L, Abtin F, Kee S, Nicholas SB, Vangala S, Wilson J (2021) A system-wide population health value approach to reduce hospitalization among chronic kidney disease patients: an observational study. J Gen Intern Med 36:1613–1621 PubMed DOI

Sawicki OA, Mueller A, Klaaßen-Mielke R, Glushan A, Gerlach FM, Beyer M, Wensing M, Karimova K (2021) Strong and sustainable primary healthcare is associated with a lower risk of hospitalization in high risk patients. Sci Rep 11:4349 PubMed DOI PMC

Prikhodina L, Ehrich J, Shroff R, Topaloglu R, Levtchenko E, European Society for Paediatric Nephrology (2020) The European Society for Paediatric Nephrology study of pediatric renal care in Europe: comparative analysis 1998–2017. Pediatr Nephrol 35:103–111 PubMed DOI

Gardner JK, Thomas-Hawkins C, Fogg L, Latham CE (2007) The relationships between nurses’ perceptions of the hemodialysis unit work environment and nurse turnover, patient satisfaction, and hospitalizations. Nephrol Nurs J 34:271–281 PubMed

Casimir G (2019) Why children’s hospitals are unique and so essential. Front Pediatr 7:305 PubMed DOI PMC

Ehrich J, Molloy E, Kerbl R, Pettoello-Mantovani M, Vural M, Gerber-Grote A (2017) Conceptual design of future children’s hospitals in Europe: the role of caregivers in transferring new concepts from theory into practice. J Pediatr 184:244–245 PubMed DOI

Ehrich J, Molloy E, Kerbl R, Pettoello-Mantovani M, Gerber-Grote A (2017) Conceptual design of future children’s hospitals in Europe: the role of public and private stakeholders as transferors of new concepts from theory into practice. J Pediatr 183:204–205 PubMed DOI

Borzych-Duzalka D, Aki TF, Azocar M, White C, Harvey E, Mir S, Adragna M, Serdaroglu E, Sinha R, Samaille C, Vanegas JJ, Kari J, Barbosa L, Bagga A, Galanti M, Yavascan O, Leozappa G, Szczepanska M, Vondrak K, Tse KC, Schaefer F, Warady BA, International Pediatric Peritoneal Dialysis Network (IPPN) Registry (2017) Peritoneal dialysis access revision in children: causes, interventions, and outcomes. Clin J Am Soc Nephrol 12:105–112 PubMed DOI

Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F (2012) Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 32(Suppl 2):S32–S86 PubMed DOI PMC

Neu AM, Richardson T, Lawlor J, Stuart J, Newland J, McAfee N, Warady BA, SCOPE Collaborative Participants (2016) Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney Int 89:1346–1354 PubMed DOI

Neu AM, Richardson T, De Souza HG, Mahon AR, Keswani M, Zaritsky J, Munshi R, Swartz S, Sethna CB, Somers MJG, Warady BA, SCOPE Collaborative Participants (2021) Continued reduction in peritonitis rates in pediatric dialysis centers: results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative. Pediatr Nephrol 36:2383–2391 PubMed DOI

The Standardizing Care to Improve Outcomes in Pediatric Endstage Kidney Disease (SCOPE) Dialysis Collaborative. Children’s hospital association. Partnering with families to improve dialysis care. https://www.childrenshospitals.org/content/quality/product-program/scope-dialysis-collaborative . Accessed 29 Mar 2022

United States Renal Data System (USRDS) 2020 Annual Data Report (2020) End Stage Renal Disease, Chapter 7: ESRD among Children and Adolescents.  https://adr.usrds.org/2020/end-stage-renal-disease/7-%20esrd-among-children-and-adolescents . Accessed 04 Nov 2021

Pisoni RL, Arrington CJ, Albert JM, Ethier J, Kimata N, Krishnan M, Rayner HC, Saito A, Sands JJ, Saran R, Gillespie B, Wolfe RA, Port FK (2009) Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 53:475–491 PubMed DOI

Zaritsky JJ, Salusky IB, Gales B, Ramos G, Atkinson J, Allsteadt A, Brandt ML, Goldstein SL (2008) Vascular access complications in long-term pediatric hemodialysis patients. Pediatr Nephrol 23:2061–2065 PubMed DOI

Hayes WN, Watson AR, Callaghan N, Wright E, Stefanidis CJ, European Pediatric Dialysis Working Group (2012) Vascular access: choice and complications in European paediatric haemodialysis units. Pediatr Nephrol 27:999–1004 PubMed DOI

North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) 2011 Annual Dialysis Report (2011) Section 2.4A: Hemodialysis Access. https://naprtcs.org/system/files/2011_Annual_Dialysis_Report.pdf . Accessed 29 Mar 2022

Ocak G, Halbesma N, le Cessie S, Hoogeveen EK, van Dijk S, Kooman J, Dekker FW, Krediet RT, Boeschoten EW, Verduijn M (2011) Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients. Nephrol Dial Transplant 26:2611–2617 PubMed DOI

Griffiths RI, Newsome BB, Leung G, Block GA, Herbert RJ, Danese MD (2012) Impact of hemodialysis catheter dysfunction on dialysis and other medical services: an observational cohort study. Int J Nephrol 2012:673954. https://doi.org/10.1155/2012/673954 PubMed DOI PMC

Ma A, Shroff R, Hothi D, Lopez MM, Veligratli F, Calder F, Rees L (2013) A comparison of arteriovenous fistulas and central venous lines for long-term chronic haemodialysis. Pediatr Nephrol 28:321–326 PubMed DOI

Shroff R, Smith C, Ranchin B, Bayazit AK, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Ağbaş A, Aitkenhead H, Anarat A, Aoun B, Aofolaju D, Bakkaloglu SA, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Deanfield J, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Stronach L, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schmitt CP, Schaefer F (2019) Effects of hemodiafiltration versus conventional hemodialysis in children with ESKD: the HDF, Heart and Height Study. J Am Soc Nephrol 30:678–691 PubMed DOI PMC

De Zan F, Smith C, Duzova A, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Agbas A, Anarat A, Aoun B, Bakkaloglu SA, Borzych-Dużałka D, Bulut IK, Habbig S, Krid S, Licht C, Litwin M, Obrycki L, Paglialonga F, Ranchin B, Samaille C, Shenoy M, Sinha MD, Spasojevic B, Yilmaz A, Fischbach M, Schmitt CP, Schaefer F, Vidal E, Shroff R (2021) Hemodiafiltration maintains a sustained improvement in blood pressure compared to conventional hemodialysis in children — the HDF, heart and height (3H) study. Pediatr Nephrol 36:2393–2403 PubMed DOI

Shroff R, Bayazit A, Stefanidis CJ, Askiti V, Azukaitis K, Canpolat N, Agbas A, Anarat A, Aoun B, Bakkaloglu S, Bhowruth D, Borzych-Dużałka D, Bulut IK, Büscher R, Dempster C, Duzova A, Habbig S, Hayes W, Hegde S, Krid S, Licht C, Litwin M, Mayes M, Mir S, Nemec R, Obrycki L, Paglialonga F, Picca S, Ranchin B, Samaille C, Shenoy M, Sinha M, Smith C, Spasojevic B, Vidal E, Vondrák K, Yilmaz A, Zaloszyc A, Fischbach M, Schaefer F, Schmitt CP (2018) Effect of haemodiafiltration vs conventional haemodialysis on growth and cardiovascular outcomes in children — the HDF, heart and height (3H) study. BMC Nephrol 19:199 PubMed DOI PMC

Ağbaş A, Canpolat N, Çalışkan S, Yılmaz A, Ekmekçi H, Mayes M, Aitkenhead H, Schaefer F, Sever L, Shroff R (2018) Hemodiafiltration is associated with reduced inflammation, oxidative stress and improved endothelial risk profile compared to high-flux hemodialysis in children. PLoS One 13:e0198320. https://doi.org/10.1371/journal.pone.0198320 PubMed DOI PMC

Ruebner RL, De Souza HG, Richardson T, Bedri B, Marsenic O, Iorember F, Warejko JK, Warady BA, Neu AM (2022) Epidemiology and risk factors for hemodialysis access-associated infections in children: a prospective cohort study from the SCOPE collaborative. Am J Kidney Dis 80:186–195 PubMed DOI

Shroff R, Calder F, Bakkaloğlu S, Nagler EV, Stuart S, Stronach L, Schmitt CP, Heckert KH, Bourquelot P, Wagner AM, Paglialonga F, Mitra S, Stefanidis CJ, European Society for Paediatric Nephrology Dialysis Working Group (2019) Vascular access in children requiring maintenance haemodialysis: a consensus document by the European Society for Paediatric Nephrology Dialysis Working Group. Nephrol Dial Transplant 34:1746–1765 PubMed DOI