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Abstract: PO0966

Peritoneal Dialysis Discontinuation: Trends and Risk Factors

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Breck, Andrew, Insight Policy Research Inc, Arlington, Virginia, United States
  • Marr, Jeffrey, Insight Policy Research Inc, Arlington, Virginia, United States
  • Esposito, Dominick, Insight Policy Research Inc, Arlington, Virginia, United States
  • Huff, Edwin D., Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
Background

Increasing use of dialysis home modalities among ESRD patients is a Centers for Medicare and Medicaid Services priority. This can be accomplished by increasing use of home dialysis among incident patients or by reducing PD discontinuation. We explore trends in PD persistence and risk factors associated with PD discontinuation.

Methods

We identified incident ESRD patients from 2008 to 2018 who received peritoneal dialysis in their third month of ESRD treatment. We used data from CROWNWeb and Medicare claims to determine the patient’s modality 1, 2, and 3 years after initiation of ESRD treatment. We summarize trends in share of incident PD patients who were treated with PD at each follow up and describe differences by patient and facility characteristics.

Results

From 2008 to 2017, approximately 70 percent of incident PD patients remained on PD after 1 year of dialysis, 50 percent after 2 years, and 30 percent after 3 years of dialysis (figure 1). Over these years the percentage of incident PD patients treated with PD after two years rose from 47.9 to 52.3 percent. The rate of two-year PD persistence has declined modestly since a peak of 53.1 percent in 2013. PD patients treated at DaVita facilities were more likely than those treated at FMC or independent facilities to remain on PD after two years. PD patients treated at facilities with a higher share of PD patients were more likely to remain on PD after two years. Among incident PD patients, the rate of peritonitis during the first year of dialysis declined from 33.5 to 21.7 between 2010 and 2018. Peritonitis was more common among dual eligible patients, Black and American Indian/Alaska Native patients, and overweight or obese patients.

Conclusion

Differences in PD discontinuation and peritonitis incidence across patient and facility subgroups represent opportunities for future quality improvement efforts.

Funding

  • Other U.S. Government Support