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Abstract: TH-PO375

Peritoneal Dialysis Utilization in US Markets and Associated Hospitalization 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 hospitalization risk than in-center hemodialysis (HD) during the first and second years of dialysis. However, increased utilization of PD in a local area may move higher-risk patients from HD to PD, thus attenuating the hospital admission (HA) rate ratio (RR). We assessed the influence of PD utilization in US markets on HA RRs 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 admission rate between 3 and 36 months after dialysis initiation, without censoring for modality change and with fixed effects for markets; only the subset of Medicare patients were included in the model.

Results

The cohort included 323,045 incident dialysis patients in 236 markets. Overall PD utilization was 8.8%. Market-specific HA rates in PD and HD patients are displayed. Market-adjusted HA RRs for PD versus HD were 0.81 with local PD utilization of 2-3% (number of markets, 12), 0.86 with utilization of 4-5% (27), 0.86 with utilization of 6-7% (47), 0.82 with utilization of 8-11% (90), 0.90 with utilization of 12-15% (42), and 0.95 with utilization of ≥16% (18). Compared to the market-adjusted HA RR with local PD utilization of 2-3%, RRs with utilization of ≥12% were significantly different (P < 0.05).

Conclusion

Across a gradient of local PD utilization from 2% to 12%, HA RRs for PD versus HD are similar. Local PD utilization ≥12% is associated with attenuated RRs.

Funding

  • Commercial Support