Social Risk Factors and Peritoneal Dialysis Use Among Maintenance Dialysis Patients: A National Cross-Sectional Study

Peritoneal dialysis (PD) utilization remains lower in the United States compared with other countries. Data regarding the presence and association of patient-level social risk factors (SRFs) with PD use are lacking.

Multicenter cross-sectional study.

Maintenance dialysis patients receiving in-center hemodialysis or peritoneal dialysis with dialysis vintage <2 years who dialyzed between 2023 and 2025 at a medium-size, national dialysis provider.

Patient-level SRFs (housing, food, transportation, utility insecurity, and interpersonal safety) ascertained using the Accountable Health Communities Health-Related Social Needs Screening Tool.

Nonreceipt of PD at the time of social risk screening.

Total SRF burden was tallied and categorized (0 (referent), 1, or >1). Adjusted logistic regression models accounted for demographics, comorbid conditions, dialysis vintage, and facility-level clustering. Sensitivity analysis were employed to explore the effect of an alternate definition of SRF burden.

Among 7,237 patients treated at 244 dialysis facilities, mean age was 64 ± 15 years, 43% were female, 26% were non-Hispanic Black, and 1,305 (18%) individuals received PD. One or more than 1 patient-level SRF was present in 9% and 3% of patients, respectively. Food insecurity (7%) and housing instability (4%) were most common. After adjustment, presence of 1 and more than 1 SRF was associated with higher odds of nonreceipt of PD as compared with no SRFs [adjusted odds ratio = 1.46 (95% confidence interval 1.10-1.92) and 2.27 (1.35-3.82), respectively]. Both housing instability and transportation insecurity were independently associated with nonreceipt of PD after adjustment.

Cross-sectional; residual confounding.

Patient-level SRFs, including housing instability and transportation insecurity, are associated with nonreceipt of PD among maintenance dialysis patients. These findings should be explored in longitudinal analyses to identify potential patient- and policy-level interventions to improve PD utilization.