Trends in chronic peritoneal dialysis utilization in New England

Area of Science:

• Nephrology
• Renal Medicine
• Dialysis Therapies

Background:

• Chronic peritoneal dialysis (CPD) utilization is decreasing in the United States.
• Technique failure and center size are implicated factors in CPD decline.
• Previous studies indicated higher technique failure rates in smaller CPD units.

Purpose of the Study:

• To investigate if declining CPD utilization rates are associated with changes in small versus large CPD units.
• To analyze trends in CPD patient census based on unit size between 2000 and 2008 in New England.
• To identify potential shifts in CPD care delivery models.

Main Methods:

• Analysis of the 2000 overall census of individual CPD units in Network #1, New England.
• Categorization of CPD units into two size groups: fewer than 25 patients and 25 or more patients.
• Comparison of CPD patient census and unit numbers from January 1, 2000, to December 31, 2008.

Main Results:

• The total CPD patient population saw a modest 2% increase from 2000 to 2008.
• The number of CPD units increased from 85 to 95 during the study period.
• Larger units (≥25 patients) experienced a significant average decline of 34% in their CPD census, while smaller units showed an increase in total patient numbers.

Conclusions:

• Declining CPD utilization is primarily driven by a significant decrease in patient census within larger treatment centers.
• The growth in the number of smaller CPD units did not offset the decline observed in larger units.
• Further research is necessary to elucidate the specific reasons behind the decline in CPD census in larger units.