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Abstract: SA-PO662

Fewer Communities Left Behind: Peritoneal Dialysis (PD) Initiation Patterns by Health Service Area in an Era of Expansion

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Knapp, Christopher D., Hennepin Healthcare System Inc, Minneapolis, Minnesota, United States
  • Li, Shuling, Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Kou, Chuanyu, Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Weinhandl, Eric D., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Hart, Allyson, Hennepin Healthcare System Inc, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare Research Institute Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background

Use of peritoneal dialysis (PD) has historically varied by community and region, with racially diverse, urban, and northeastern areas having lower utilization of PD than rural, less diverse, and western areas. The trend of PD utilization since 2010 in the communities impacted by these disparities is unclear.

Methods

We used the United States Renal Database System to examine patterns of PD use in Health Service Areas (HSA) in the US. We assigned each of the 754 HSAs with ≥20 prevalent dialysis patients in 2009-2010 into “high” (>11% of dialysis patients using PD), “medium” (5.5-11%) or “low” (<5.5%) PD use categories. We then identified incident dialysis patients from 2011-2020 and described patient characteristics and trends in percentage of patients using PD on day 1 of dialysis according to HSA PD-use category. We used logistic regression with adjustment for demographics to determine whether changes in PD use differed across HSA categories.

Results

1,195,588 incident dialysis patients were included. In the 2011-2020 period, low-use HSAs had a lower percentage of incident dialysis patients who were White (48.1% vs 63.2%) and a higher percentage of incident dialysis patients living in urban areas (86.3% vs 69.4%) or in the Northeastern US (38.8% vs 8.9%) compared with high-use HSAs. The percentage of patients initiating PD increased in each category of HSA (Figure). The adjusted odds of a patient initiating PD increased more in low-use HSAs (OR per 5 years 1.49, 95% Confidence Interval [CI] 1.45-1.52) than in medium or high-use categories (OR 1.37, 95% CI 1.35-1.39; OR 1.16, 95% CI 1.13-1.19, respectively).

Conclusion

During the 2010s, PD use increased more rapidly in areas where the modality had previously been less-utilized, suggesting that the national increase in PD utilization was geographically robust and did not result in widening differences among HSAs.

Funding

  • NIDDK Support