Abstract: FR-PO1079
Real-World Analysis of the Association Between Kidney Disease Education (KDE) and Peritoneal Dialysis (PD)
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
- Dabbous, Firas, Thermo Fisher Scientific Inc, Waltham, Massachusetts, United States
- Brown, Julie, Vantive US Healthcare LLC, Deerfield, Illinois, United States
- Shridharmurthy, Divya, Thermo Fisher Scientific Inc, Waltham, Massachusetts, United States
- Huse, Samuel, Thermo Fisher Scientific Inc, Waltham, Massachusetts, United States
- Do Rego, Bronwyn, Vantive US Healthcare LLC, Deerfield, Illinois, United States
- Lassagne, Reginald, Vantive US Healthcare LLC, Deerfield, Illinois, United States
- Danielson, Vanessa, Vantive US Healthcare LLC, Deerfield, Illinois, United States
- Jain, Haripriya, Thermo Fisher Scientific Inc, Waltham, Massachusetts, United States
Background
Medicare covers KDE for structured pre-dialysis counseling on kidney replacement therapy modalities. Despite this benefit, most patients with advanced Chronic Kidney Dialysis (CKD) initiate dialysis urgently, predominantly via hemodialysis (HD), without prior education, contributing to underutilization of PD. Building on Shukla et al., this study characterizes real-world KDE utilization before dialysis initiation across payer types and examines the association between modality at initiation (PD vs. HD) and KDE receipt, as well as whether pre-dialysis KDE is associated with 90-day PD persistence.
Methods
We conducted a retrospective cohort study using the Komodo Health database (2019–2024). Adults with incident end stage kidney disease (ESKD) initiating PD (cases) or HD (controls) during the identification period 2020–2024 were included; the dialysis initiation date served as the index date. All patients had ≥12 months of continuous pre-index enrollment and no prior dialysis. KDE was identified via HCPCS codes G0420/G0421. Cases and controls were matched on age, sex, Charlson Comorbidity Index, insurance type (Medicare FFS/ advantage, and commercial plans), and calendar-year quarter of initiation. Conditional logistic regression was used to evaluate the association between initiation modality and pre-dialysis KDE. Among PD initiators, Cox proportional hazards model was used to compare time to PD discontinuation within 90 days by KDE receipt.
Results
Pre-dialysis KDE utilization was low across the cohort (~1%). After matching, PD and HD cohorts were well balanced. Compared to HD, PD initiation was associated with significantly higher odds of prior KDE. Among PD initiators, KDE receipt was associated with a significantly lower risk of PD discontinuation within 90 days.
Conclusion
Pre-dialysis KDE remains markedly underutilized despite established Medicare coverage. Consistent with existing literature, these findings highlight a persistent gap between Medicare's intent and real-world use of a covered benefit. Expanding access to structured pre-dialysis education may support informed modality selection, increase home dialysis uptake, and improve early persistence in ESKD. Payer-level variation, including whether Medicare Advantage plans reimburse G0420/G0421 consistent with traditional Medicare, warrants further investigation as a lever for closing the home dialysis access gap.
Funding
- Commercial Support – Vantive