Abstract: FR-PO1089
Availability Is Not Access: State-Level Peritoneal Dialysis Infrastructure and Patient Use, 2018-2022
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
- Shanavas, Ridah Shaista, The Synapse Foundation, Hyderabad, Telangana, India
- Vavilla, Devi Sivani, The Synapse Foundation, Hyderabad, Telangana, India
- Farhan, Muhammad, Nephrology Associates of Kentuckiana, Louisville, Kentucky, United States
Background
Peritoneal dialysis (PD) supports home-based care and patient autonomy, yet remains underused in the United States. Facility availability is often treated as a proxy for access, but patients also need timely modality education, catheter pathways, trained staff, and sustained program support. We examined whether state-level PD infrastructure related differently to incident PD initiation and prevalent PD use.
Methods
We conducted an ecological state-year analysis of 50 states and DC from 2018–2022 using USRDS data linked with dialysis facility capacity measures. Incident PD share was defined as incident PD divided by incident PD plus incident HD. Prevalent PD share was defined as prevalent PD divided by the total prevalent dialysis population. Infrastructure measures included facility breadth, program depth, and PD-active facility density. Multivariable models assessed associations with PD use, with robustness checks using weighting, clustered standard errors, and state/year fixed effects.
Results
The sample included 255 state-year observations. Facility breadth and program depth were associated with incident PD share in pooled and weighted models, but not after state/year fixed-effects adjustment. PD-active facility density was not consistently associated with incident PD share. In contrast, PD-active facility density was consistently associated with prevalent PD share, including in fixed-effects models (β=0.004226, 95% CI 0.000712–0.007741, p=0.0194). This pattern suggests that initiation and sustained PD use reflect different access processes. Breadth-depth typology showed descriptive differences in PD use, admission rate, and hospitalized days, but these findings were exploratory rather than causal.
Conclusion
State-level PD availability did not consistently translate into PD initiation. PD-active facility density was the most robust infrastructure correlate of prevalent PD share, suggesting that sustained PD use may depend on mature home dialysis programs capable of supporting education, catheter access, training, troubleshooting, and retention. Efforts to expand PD should measure not only whether facilities offer PD, but whether local systems can help patients start, sustain, and safely remain on home dialysis.
Acknowledgment
AI was used for language editing; authors reviewed and take responsibility for all content.