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Abstract: SA-PO057

Disparities in Home Dialysis Utilization Among Dual Eligible Medicare Fee-for-Service (FFS) Beneficiaries

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health


  • Belowich, Emily, Avalere Health, Washington, District of Columbia, United States
  • Fagan, Jack, Avalere Health, Washington, District of Columbia, United States
  • Parekh, Shalini, Avalere Health, Washington, District of Columbia, United States
  • Gooding, Mark John, Avalere Health, Washington, District of Columbia, United States

Since the 2019 Advancing American Kidney Health (AAKH) initiative, the federal government has focused on enhancing prevention and treatment of kidney disease, including introducing new incentives for home dialysis use for patients who require renal replacement therapy. Access to optimal kidney care services influences greater mortality and morbidity rates. We hypothesized that patients with lower socioeconomic status may have lower use of home dialysis due to the nature of what is required to access this dialysis modality (e.g., health literacy, caregiver support, proper home infrastructure).


We used 100% Medicare Fee-For-Service (FFS) claims data to identify patients with End Stage Renal Disease (ESRD) who received renal replacement therapy (peritoneal dialysis and hemodialysis) excluding beneficiaries who have received a kidney transplant between January 2019 to June 2022. We stratified beneficiaries by Medicaid dual eligibility status.


Between Q1 2019 – Q2 2022, the rate of home dialysis utilization grew from 12.3% to 15.9% across all Medicare FFS beneficiaries. In Q2 2022, 12.0% of 113,226 dual-eligible beneficiaries utilized home dialysis compared to 19.7% of 115,497 non-dual eligible beneficiaries utilizing home dialysis (p<0.01). This difference in utilization was consistent across the period of analysis; the rate of non-dual eligibles utilizing home dialysis was 7.7 percentage points higher than dual eligible beneficiaries in Q1 2019 and 7.4 percentage points higher in Q1 2022.


The AAKH initiative – compounded by the COVID-19 pandemic – served as a catalyst to advancing home dialysis. However, these findings indicate that access to care is still greatly influenced by socioeconomic status, even with policy changes that intentionally aim to close disparity gaps. Future research and policy should seek to identify how disparities in socioeconomic status and associated challenges can be addressed to allow for equitable access to all treatment modalities for ESRD.

Rates of Unique Medicare FFS Patients with a Home Dialysis Service in the Given Quarter
StrataQ1 2019Q2 2019Q3 2019Q4 2019Q1 2020Q2 2020Q3 2020Q4 2020Q1 2021Q2 2021Q3 2021Q4 2021Q1 2022Q2 2022
All FFS Beneficiaries12.3%12.5%12.7%13.0%13.4%13.4%13.9%14.1%14.7%14.8%15.2%15.4%15.9%15.9%
Not Dual Eligible16.4%16.5%16.8%17.2%17.6%17.5%18.0%18.2%18.8%18.8%19.1%19.3%19.9%19.7%
Medicaid Full/Partial Dual in Any Month of Quarter9.0%9.2%9.4%9.6%9.9%10.1%10.5%10.6%11.0%11.2%11.4%11.6%11.9%12.0%