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Abstract: FR-OR008

Peritoneal Dialysis Utilization in US markets and Associated Mortality Rate Ratios for Peritoneal Dialysis Versus Hemodialysis

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

In the United States, peritoneal dialysis (PD) is associated with lower mortality risk than in-center hemodialysis (HD) during the first year of dialysis. However, increased utilization of PD in a local area may move higher-risk patients from HD to PD, thus attenuating the mortality rate ratio (MRR). We assessed the influence of PD utilization in US markets on MRRs for PD versus HD.

Methods

We analyzed data from the United States Renal Data System. We identified incident dialysis patients in 2006-2013 and retained patients in markets with ≥500 patients. For each area, we calculated the percentage of patients on PD within 3 months of dialysis initiation. Using Poisson regression, we assessed the association of that percentage with the mortality rate between 3 and 36 months after dialysis initiation, without censoring for modality change and with fixed effects for markets.

Results

The cohort included 586,718 incident dialysis patients in 236 markets. Overall PD utilization was 8.8%. Market-specific mortality rates in PD and HD patients are displayed. Market-adjusted MRRs for PD versus HD were 0.56 with local PD utilization of 2-3% (number of markets, 12), 0.55 with utilization of 4-5% (27), 0.58 with utilization of 6-7% (47), 0.61 with utilization of 8-11% (90), 0.65 with utilization of 12-15% (42), 0.64 with utilization of 16-19% (11), and 0.77 with utilization of ≥20% (7). Compared to the market-adjusted MRR with local PD utilization of 2-3%, only the MRR with utilization of ≥20% was significantly different (P < 0.01).

Conclusion

Across a gradient of local PD utilization from 2% to 20%, MRRs for PD versus HD are similar. Expanded utilization of PD in incident dialysis patients may have limited negative effect on population survival.

Funding

  • Commercial Support