Kidney Week

Abstract: FR-PO1106

Treatment Modality-Specific Patterns of Antibiotic Use in US Patients on Dialysis

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

Authors

• Meigel, Felix J., Renal Research Institute LLC, New York, New York, United States

Felix J. Meigel, PhD

• Rigodon, Vladimir, Renal Research Institute LLC, New York, New York, United States

Vladimir Rigodon, MD

• Winter, Anke, Renal Research Institute LLC, New York, New York, United States

Anke Winter, MD

• Van Zandt, Carly R., Renal Research Institute LLC, New York, New York, United States

Carly R. Van Zandt, MS

• Chatoth, Dinesh K., Fresenius Medical Care, Global Medical Office, Fresenius Kidney Care, Waltham, Massachusetts, United States

Dinesh K. Chatoth, MD, FASN

• Usvyat, Len A., Renal Research Institute LLC, New York, New York, United States

Len A. Usvyat, PhD, FASN

• Fuertinger, Doris H., Renal Research Institute LLC, New York, New York, United States

Doris H. Fuertinger, PhD

Background

Infection risk and antibiotic treatment strategies differ across dialysis modalities. We evaluated antibiotic utilization patterns by modality and route of administration in a large US dialysis cohort.

Methods

We analyzed adult patients receiving in-center hemodialysis (IHD), home hemodialysis (HHD), or peritoneal dialysis (PD) in Fresenius Medical Care North America between August 2024 and July 2025. Intravenous (IV) and intraperitoneal (IP) antibiotic administrations from a predefined panel (Cimino et al., Drugs 2021) were identified and categorized by predominant activity (Gram-positive, Gram-negative, or both). Patient-time was computed as follow-up time on each modality, converted to patient-months. Antibiotic use was expressed as administrations per 100 patient-months and compared across modalities and administration routes.

Results

The cohort included 251,173 patients contributing 2.44M patient-months (HHD: 0.10M pat-mo, IHD: 2.08M pat-mo, PD: 0.26M pat-mo). Antibiotic utilization varied by modality, with the highest rates observed in PD, followed by IHD and HHD (31.4, 14.8, and 9.7 per 100 pat-mo, respectively). In PD, IP administration accounted for the majority of antibiotic use (90.5% vs 9.5%). Antibiotic composition varied across modality and route. IV use in IHD, HHD, and PD was predominately directed at Gram-positive organisms (73.4%, 78.4%, 66.5%), with vancomycin comprising the largest share (52.8%, 48.1%, 56.5%). In contrast, PD-IP use showed greater representation of Gram-negative agents (53.4%), driven largely by ceftazidime (49.7%).

Conclusion

Antibiotic utilization in US dialysis patients differs substantially by treatment modality and route of administration. PD is characterized by frequent IP antibiotic use and a distinct spectrum of coverage compared with hemodialysis modalities. These findings highlight modality-specific differences in infection management.

Funding

• Commercial Support – Fresenius Medical Care