Scaling Peritoneal Dialysis: Center Effects Thresholds in US Facilities

Area of Science:

• Nephrology
• Public Health
• Health Services Research

Background:

• Center effects in peritoneal dialysis (PD) link facility patient volume to patient outcomes, with larger centers showing better results.
• Recent U.S. policies aimed to increase PD utilization, but their impact on center-level thresholds for improved outcomes is unclear.
• This study investigated changes in PD patient volume thresholds at U.S. dialysis facilities.

Purpose of the Study:

• To characterize facility-level changes in PD patient volume thresholds across the United States from 2010 to 2021.
• To assess the impact of recent policy changes on PD program size and utilization.
• To identify temporal trends and regional variations in PD program volume.

Main Methods:

• Retrospective observational study using the CMS Dialysis Facility Compare database (2010-2021).
• Analyzed 8,982 unique U.S. dialysis facilities.
• Employed mixed-effects logistic regression to examine trends in facilities meeting PD volume thresholds (>0, >20, >50 patients), adjusting for facility characteristics and region.

Main Results:

• Facilities offering PD increased from 38.4% to 44.6% between 2010 and 2021.
• The proportion of PD facilities with large (>20 patients) and very large (>50 patients) programs significantly increased.
• Facilities in 2021 had substantially higher odds of maintaining larger PD programs compared to 2010, with persistent regional disparities favoring Western facilities.

Conclusions:

• The U.S. has experienced growth in large peritoneal dialysis programs, potentially achieving beneficial center effects.
• Current policies have encouraged some PD program expansion, but wider adoption and addressing regional disparities necessitate further interventions.
• Opportunities exist to broaden PD access and ensure equitable outcomes across all regions.