Peritoneal Dialysis-Associated Peritonitis Trends Using Medicare Claims Data, 2013-2017

Area of Science:

• Nephrology
• Epidemiology
• Health Services Research

Background:

• Peritoneal dialysis (PD)-associated peritonitis is a significant complication limiting its use in kidney failure patients.
• Understanding peritonitis trends and risk factors is crucial for improving PD outcomes.
• Large-scale studies are needed to enhance the understanding of peritonitis in diverse patient populations.

Purpose of the Study:

• To develop and validate a method for measuring PD-associated peritonitis rates using Medicare claims data.
• To characterize peritonitis trends over time.
• To identify clinical risk factors associated with PD-associated peritonitis.

Main Methods:

• Retrospective cohort study utilizing US Renal Data System standard analysis files (2013-2017).
• Inclusion of patients receiving PD covered by Medicare fee-for-service (FFS) insurance.
• Peritonitis identification using ICD-9 and ICD-10 codes, with aggregation of closely spaced claims into single episodes.

Main Results:

• Identified 70,271 peritonitis episodes from 396,289 claims, noting coding heterogeneity.
• Overall peritonitis rate was 0.54 episodes per patient-year (EPPY), decreasing to 0.45 EPPY excluding catheter codes.
• Rates declined by 5% annually and varied by age, race, and prior peritonitis history.

Conclusions:

• PD-associated peritonitis rates have declined over time and are lower in older patients.
• Coding heterogeneity presents a limitation, potentially leading to false positives from catheter-related codes.
• A claims-based approach is a viable and promising method for studying PD-associated peritonitis.