Peritoneal Dialysis or Hemodialysis: Present and Future Trends in the United States

In 2013, 88.4% of all incident end-stage renal disease (ESRD) patients began renal replacement therapy with hemodialysis (HD) while 9.0% began with peritoneal dialysis (PD). The remaining 2.6% received a preemptive kidney transplant. In the US, outpatient HD units are widely distributed and economy of scale has resulted in HD being the most common ESRD modality. Use of PD and preemptive kidney transplant were relatively more common in younger groups and relatively less common among Black and Hispanic patients. Of note is that the new Medicare reimbursement system, known as the 'bundle', provides substantial financial incentives to do PD as opposed to in-center HD. By the end of 2013, 63.9% of all prevalent ESRD cases were receiving HD, 6.9% were being treated with PD, and 29.3% had a functioning kidney transplant. Distributions of modality use by patient characteristics generally mirror those for incident patients. PD and kidney transplant were more commonly used among patients who were younger and were more likely to be non-Hispanic Whites. Differences in the use of home dialysis (PD and HD) are largely driven by differences among individual dialysis centers or groups of centers, rather than by large-scale regional effects. Thus, the future use of PD or home HD will be driven by the proclivities of the largest dialysis providers, which, in turn, are driven by financial reimbursement.