Outcomes by Dialysis Modality in a Safety-Net Population: A 10-Year Retrospective Cohort Study.

Area of Science:

• Nephrology
• Transplantation Medicine
• Public Health

Background:

• In-center hemodialysis (HD) and peritoneal dialysis (PD) are treatments for kidney failure (KF).
• PD involves patient self-care, potentially offering health benefits.
• Kidney transplantation (KT) is the preferred outcome for KF patients, but disparities exist in KT access, particularly among low-income dialysis recipients.

Purpose of the Study:

• To compare transplant evaluation and listing rates between propensity-matched incident hemodialysis (HD) and peritoneal dialysis (PD) patients.
• To investigate differences in KT outcomes among low-income dialysis recipients within a safety-net health system.

Main Methods:

• A retrospective study matched 150 adult PD patients with 150 HD patients 1:1 based on demographics and comorbidities.
• Key outcomes included transplant evaluation, listing status, reasons for non-listing, transplantation rates, time to transplant, hospitalization, and mortality.

Main Results:

• Propensity-matched HD and PD groups were similar in age, gender, race/ethnicity, language, comorbidities, education, and insurance.
• PD patients had significantly higher rates of transplant evaluation (86.0% vs. 70.0%) and listing (51.3% vs. 31.3%) compared to HD patients.
• While more PD patients underwent KT (22.0% vs. 17.3%), the difference was not statistically significant.

Conclusions:

• Patients on PD demonstrated superior rates of KT evaluation and subsequent listing compared to those on HD.
• Equitable implementation of PD may enhance KT access, even within underserved populations.
• Further research is needed to understand the factors driving these differences and optimize KT pathways for all dialysis modalities.