Abstract: TH-PO310
Use of Peritoneal Dialysis in Urban Boroughs of New York City
Session Information
- Peritoneal Dialysis: CVD, Fluid, Nutrition
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Yap, Ernie, SUNY Downstate Medical Center, New York, New York, United States
- Sharma, Shuchita, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- El Shamy, Osama, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Weinberg, Alan D., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Uribarri, Jaime, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Saggi, Subodh J., SUNY Downstate Medical Center, New York, New York, United States
Background
Peritoneal Dialysis (PD) is currently underutilized in the United States. Barriers to initiating PD such as geographical limitations, access to catheter care or trained personnel are less relevant in urban metropolitan cities, which may harbor heretofore unknown barriers to PD. We sought to describe the epidemiology of PD utilization within New York City in comparison to Boston, New York State (NYS) and the United States (US).
Methods
From the 2010-2016 US Renal Data Service, we estimated the odds of starting PD compared to hemodialysis (HD) in Brooklyn, Bronx, Queens, and Manhattan in comparison to Boston, NYS and the US. Next, we analyzed whether factors known to influence PD utilization such as diabetes mellitus (DM) as the primary diagnosis, age >65 years, gender and race played a role here. Statistical analysis was performed using SPSS 24.
Results
Between 2010 and 2016, the odds of starting PD vs HD in NYS compared to the rest of the US was 0.49 (95% CI:0.47-0.52; p<0.0001). The odds of starting PD vs HD in Brooklyn, Bronx, Queens and Manhattan in comparison to NYS were 0.30 (0.25-0.36; <0.0001), 0.56 (0.47-0.67; <0.0001), 0.66 (0.54-0.80; <0.0001) and 0.61 (0.52-0.71; <0.0001), respectively. In 2016, the odds of starting PD in Brooklyn, Bronx, Queens, Manhattan and Boston in comparison to the US were 0.14 (0.08-0.22; <0.0001), 0.39 (0.27-0.56; <0.0001), 0.32 (0.23-0.45; <0.0001), 0.54 (0.36-0.79; 0.002) and 0.89 (0.58-1.4; 0.624), respectively. Analysis of factors that influence PD initiation showed the following for Brooklyn: male sex (p=0.18) black race (0.06), age> 65 years (<0.0001) and DM (0.07) and Boston: male sex (0.45), black race (0.36), age> 65 years (<0.001) and DM (0.17). The percentage of residents in Brooklyn and Boston age >65 years in 2018 were 13.5% and 11%, respectively.
Conclusion
Our study demonstrated low odds of PD utilization for ESRD patients in NYC. There were segmental disparities suggesting borough-specific factors, perhaps socioeconomic and cultural. Brooklyn has the highest ESRD rates but lowest PD use. Similar findings were not seen in Boston. Commonly cited factors that influence PD usage such as DM as the primary diagnosis, gender and race were not statistically significant, while age seems to be an important factor. A concerted effort to identify and overcome barriers to PD amongst the elderly is needed