ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO312

Regionalization of Peritoneal Dialysis Services in an Era of Health Reform, 2006-2013

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis


  • Hoffman, Abby, Duke University, Durham, North Carolina, United States
  • Sloan, Caroline E., Duke University, Durham, North Carolina, United States
  • Maciejewski, Matthew L., Durham VAHCS, Durham, North Carolina, United States
  • Coffman, Cynthia, Duke University Medical Center, Durham, North Carolina, United States
  • Sanders, Linda L., Duke University Medical Center, Durham, North Carolina, United States
  • Hirth, Richard A., University of Michigan, Ann Arbor, Michigan, United States
  • Lee, Shoou-Yih Daniel, University of Michigan, Ann Arbor, Michigan, United States
  • Wang, Virginia, Duke University, Durham, North Carolina, United States

Over the last 15 years, Medicare has adjusted payment policy to promote peritoneal dialysis (PD) provision and use. Facility PD provision has grown modestly despite notable growth in patient PD use. A potential explanation underlying this trend is possible regionalization of PD services among dialysis chains. Regionalization may improve facility finances while maintaining patient access because: (1) consolidation into fewer chains allows for economies of scale and (2) as a home-based modality, PD requires minimal travel and impacts from regionalization of services. This study is the first to empirically assess the extent of PD program regionalization among dialysis chains.


We conducted a retrospective cohort study of non-federal US outpatient dialysis chains 2005-2013 with data from the US Renal Data System and Medicare Provider of Service files. Two outcomes were observed at the chain-hospital referral region level in 3-year time periods 2005-2013:
- PD regionalization – decrease in PD facilities without decreasing PD patients
- PD expansion – increase in PD patients without increasing PD facilities
Generalized estimating equations with a logit link identified correlates of PD regionalization and expansion adjusting for chain and market characteristics.


During the study, there were 2,799 market-chains; 49% large dialysis organizations ([LDOs] DaVita or Fresenius). We observed PD regionalization 103 market-chains and PD expansion in 728. Regionalization increased from 29 market-chains in 2005-2007 to 44 in 2011-2013. Expansion also increased from 175 market-chains to 293. In adjusted expansion increased over time (odds ratio [OR] 1.33; 95% confidence interval [CI] 1.18-1.49). Overall, LDOs had higher odds of regionalization (OR 3.92, CI 2.39-6.42) and expansion (OR 1.79; CI 1.48-2.17).


We provide early evidence that chains are expanding PD services and that LDOs are more likely to regionalize PD services. Dialysis chains have not regionalized PD services in response to reforms 2005-2013; but continued monitoring of PD care patterns will inform long-term effects of dialysis payment reform on dialysis industry service strategies and identify important implications for patient care.


  • NIDDK Support