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Kidney Week

Abstract: PO1252

Higher Utilization of Peritoneal Dialysis Following the Executive Order on Advancing American Kidney Health

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Weinhandl, Eric D., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background

On July 10, 2019, the president of the United States issued an Executive Order on Advancing American Kidney Health (AAKH). As part of the order, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule regarding the End Stage Renal Disease Treatment Choices (ETC) Model, which would employ payment mechanisms in Medicare Part B to incentivize home dialysis and kidney transplantation. We assessed whether the period following the Executive Order was characterized by an increase in peritoneal dialysis (PD) utilization in incident end-stage kidney disease (ESKD) patients undergoing dialysis.

Methods

We analyzed submissions of form CMS-2728 ("ESRD Medical Evidence Report") among patients with dialysis initiation in 2017-2019, according to an April 2020 extract from the Renal Management Information System. For each calendar month in 2017-2019, we estimated the percentage of patients whose primary type of dialysis was PD. We used logistic regression to assess whether PD utilization during each quarter of 2019 exceeded corresponding norms in 2017-2018, with adjustment for age, race, and sex.

Results

The cohort comprised 375,815 incident ESKD patients undergoing dialysis. PD utilization increased each year, to an apex of 12.0% in 2019. In September and October 2019, PD utilization exceeded 13.0%, as displayed. Relative to corresponding quarters in 2017-2018, adjusted odds ratios of PD utilization in 2019 were 1.06 (95% confidence interval, 1.02-1.11) during January-March, 1.08 (1.04-1.13) during April-June, 1.16 (1.11-1.21) during July-September, and 1.16 (1.16-1.21) during October-December.

Conclusion

The Executive Order on AAKH and the proposed ETC Model together marked the advent of a period of significantly higher PD utilization among incident ESKD patients.

Funding

  • NIDDK Support