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Kidney Week

Abstract: SA-PO661

Effect of ESRD Prospective Payment System on Utilization of Peritoneal Dialysis in Patients with Kidney Allograft Failure

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

  • Gardezi, Ali I., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Yuan, Zhongyu, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Aziz, Fahad, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Parajuli, Sandesh, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Chan, Micah R., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin-Madison, Madison, Wisconsin, United States
Background

The Center for Medicare and Medicaid Services introduced ESRD Prospective Payment System (PPS) in 2011 to increase the utilization of home dialysis modalities, including peritoneal dialysis (PD). Several studies have shown a significant increase in PD utilization after PPS implementation. However, its impact on patients with kidney allograft failure remains unknown.

Methods

We conducted an interrupted time series analysis using data from the United States Renal Data System that include all adult patients with allograft failure who started dialysis between 2005 and 2019. We compared the PD utilization in the pre-PPS period (2005-2010) to the fully implemented post-PPS period (2014-2019) for early (within 90 days of dialysis initiation) and late (91-365 days) PD experience.

Results

27507 adult recipients with allograft failure started dialysis during the study period. There was no significant difference in early PD utilization between pre-PPS and post-PPS period in either immediate change called "step change" (0.3% increase; 95%CI: -1.95%, 2.54%; p=0.79) or rate of change over time called "slope change" (0.28% increase per year; 95%CI: -0.16%, 0.72%; p=0.18). Subgroup analyses revealed a trend toward higher PD utilization in post-PPS period in for-profit and large-volume dialysis units. There was a significant increase in PD utilization in post-PPS period in those units which had low PD experience in the pre-PPS period (2.2% increase; 95% CI: 1.31, 3.22; p<0.01). Similar findings were seen for the late PD experience.(Table)

Conclusion

PPS did not significantly increase the utilization of PD in patients initiating dialysis after allograft failure.

Effect of PPS on late PD experience in patients with allograft failure