The Changing Landscape of Peritoneal Dialysis in America: A Facility-Level Analysis of Growth

Peritoneal dialysis (PD) use has expanded nationwide, yet it is unclear whether this growth reflects more facilities initiating PD programs, expansion of existing programs, or both. We sought to describe national trends in PD program adoption and program size and to assess whether these patterns differed across facility and geographic characteristics.

Retrospective serial cross-sectional study.

All Medicare-certified dialysis facilities in the United States from 2010-2021.

Calendar year.

(1) Whether a facility treated ≥1 PD patient; (2) PD census among facilities with active PD programs.

We applied mixed-effects logistic and negative binomial models with random facility effects to estimate changes in PD program presence and the mean census over time. Models were adjusted for region, organizational size, profit status, and urbanicity, and included interaction terms to test for heterogeneity in temporal trends.

The number of US dialysis facilities with active PD programs increased from 38.4%-44.6% between 2010 and 2021, and among those programs, the mean PD census rose from 14.7-18.2. Relative to 2010, facilities in 2021 had higher odds of providing PD (OR, 1.61; 95% CI, 1.35-1.92), and active programs treated substantially more patients (incidence rate ratio, 1.50; 95% CI, 1.45-1.56). Nonprofit and small dialysis organizations showed the greatest likelihood of initiating PD programs, whereas for-profit and large organizations demonstrated stronger census growth. Regional differences were observed, with the West showing the largest increases in program size.

Facility-level data prevent examination of patient-level determinants; annual snapshots may miss within-year variation.

From 2010-2021, PD growth reflected both expansion of existing programs and increased program adoption, with substantial differences based on organizational structure. Tailored policy strategies may be needed to support sustained, equitable growth in PD capacity across facility types.