Abstract: FR-PO1088
Estimated Demand Does Not Explain Variation in Peritoneal Dialysis Use: A National Facility-Level Analysis
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Author
- Lassagne, Reginald, Vantive US Healthcare LLC, Deerfield, Illinois, United States
Background
Peritoneal dialysis (PD) offers clinical and quality-of-life advantages, yet remains underutilized in the United States (US). Geographic variation in PD use is well described, but the extent to which this reflects differences in underlying patient demand versus system-level factors remains unclear. We examined whether higher estimated demand is associated with greater use of PD at the facility level.
Methods
We conducted a cross-sectional facility-level analysis of 7,507 US dialysis facilities using publicly available data from Dialysis Facility Reports, Centers for Medicare and Medicaid Services (CMS) cost reports, U.S. Census, and county-level diabetes prevalence. Local end-stage renal disease (ESRD) demand was estimated using county population and diabetes prevalence and allocated to facilities based on geographic proximity (≤50 miles). Facilities without precise geocoding (n=806) were excluded from primary geographic analyses, leaving 6,701 facilities. Facilities were stratified into quintiles of estimated future ESRD inflow. PD utilization (facility-level and patient-weighted) and presence of PD activity were compared across quintiles using ANOVA and chi-square tests.
Results
Mean PD utilization remained low and stable across increasing levels of estimated demand (Q1: 11.6% vs Q5: 13.1%), with no statistical differences observed (ANOVA p=0.20). Patient-weighted PD utilization showed a similarly stable pattern. Nearly half of facilities reported no PD activity (45%-49%) across all quintiles, with no statistically significant differences (chi-square p=0.14). Median PD share remained approximately 2% across groups, with substantial within-quintile variability.
Conclusion
PD utilization does not increase in response to higher estimated patient demand. Variation in PD use therefore appears largely independent of underlying demand, and more likely reflects system-level factors such as facility capability, provider practice patterns, and care organization. Consistent with prior work, these findings suggest that efforts to expand home dialysis should therefore focus on addressing structural and organizational barriers rather than demand-driven planning alone. (Reddy et al., 2024; Damery et al., 2024; Velazquez et al., 2022).
Funding
- Commercial Support – Vantive