Chronic peritoneal dialysis in the United States: declining utilization despite improving outcomes

Area of Science:

• Nephrology
• Public Health
• Healthcare Management

Background:

• Chronic peritoneal dialysis (CPD) utilization has seen a notable decrease among incident end-stage renal disease (ESRD) patients in the United States.
• Factors such as increasing patient age, co-morbidity, and body size may partially explain this trend, but other contributing elements are suspected.
• This decline occurred despite concurrent improvements in outcomes for patients initiating CPD.

Purpose of the Study:

• To investigate the trend of peritoneal dialysis utilization among incident ESRD patients in the United States.
• To determine if demographic, case-mix, and laboratory data fully account for the observed decline in CPD use.
• To compare the trend in CPD utilization with outcomes for both CPD and hemodialysis (HD) patients during the same period.

Main Methods:

• Analysis of incident ESRD patient data in the United States from 1996 to 2003.
• Statistical evaluation of trends in peritoneal dialysis initiation rates.
• Adjustment for patient demographics, case-mix, and laboratory data to assess the significance of the observed decline.

Main Results:

• Peritoneal dialysis initiation significantly decreased from 11% (1996-1997) to 7% (2002-2003) among incident ESRD patients (P < 0.001).
• The decline in CPD utilization persisted after adjusting for patient characteristics, suggesting factors beyond age, co-morbidity, and body size.
• During this period, outcomes for incident CPD patients improved (reduced hazards for death or transfer to HD), while outcomes for incident HD patients remained stable or worsened.

Conclusions:

• The declining utilization of peritoneal dialysis among incident ESRD patients in the US is not solely explained by patient factors like age, co-morbidity, or body size.
• The decrease in CPD use occurred concurrently with improved patient outcomes, challenging assumptions about modality selection based purely on patient characteristics.
• Further research is needed to identify the multifactorial reasons behind the reduced adoption of peritoneal dialysis despite its favorable outcomes.