Why Peritoneal Dialysis is Underutilized in the United States: A Review of Inequities

Abstract

Given a choice, most patients with end-stage renal disease prefer home dialysis over in-center hemodialysis (HD). Peritoneal dialysis (PD) is a home dialysis method and offers benefits such as absence of central venous access and therefore preservation of veins, low cost, and decreased time per dialysis session, as well as convenience. Survival rate for patients on PD has increased to levels comparable to in-center HD. Despite endorsement by leaders in the medical field, professional societies, and those in government, PD has reached only 11% adoption among incident patients according to the 2019 United States Renal Data System Annual Data Report. This figure is dwarfed in comparison to rates as high as 79% in other countries. In addition, research has shown that inequities exist in PD access, which are most pronounced in rural, minority, and low-income regions as demonstrated by trends in regional PD supplies. To complicate things further, technique failure has been implicated as a major determinant of poor PD retention rates. The low initiation and retention rates of PD in the United States points to barriers within the healthcare system, many of which are in the early phases of being addressed.

Keywords

peritoneal dialysis - end-stage renal disease - hemodialysis - inequities - interventional radiology

Publikationsverlauf

Artikel online veröffentlicht:
18. Februar 2022

• References

• 1 Heaf J, Heiro M, Petersons A. et al. Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study. Clin Kidney J 2020; 14 (09) 2064-2074
• 2 Wong B, Ravani P, Oliver MJ. et al. Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities. Am J Kidney Dis 2018; 71 (03) 344-351
• 3 Saran R, Robinson B, Abbott KC. et al. US Renal Data System 2019 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2020; 75 (01, Suppl 1): A6-A7
• 4 Chan CT, Wallace E, Golper TA. et al. Exploring barriers and potential solutions in home dialysis: an NKF-KDOQI conference outcomes report. Am J Kidney Dis 2019; 73 (03) 363-371
• 5 Sloan CE, Coffman CJ, Sanders LL. et al. Trends in regional supply of peritoneal dialysis in an era of health reform, 2006 to 2013. Med Care Res Rev 2021; 78 (03) 281-290
• 6 Cho Y, See EJ, Htay H, Hawley CM, Johnson DW. Early peritoneal dialysis technique failure. . [ Review] Perit Dial Int 2018; 38 (05) 319-327
• 7 U.S. Renal Data System (USRDS), Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2018
• 8 Mehrotra R, Khawar O, Duong U. et al. Ownership patterns of dialysis units and peritoneal dialysis in the United States: utilization and outcomes. Am J Kidney Dis 2009; 54 (02) 289-298
• 9 Sloan CE, Coffman CJ, Sanders LL. et al. Trends in peritoneal dialysis use in the United States after Medicare payment reform. Clin J Am Soc Nephrol 2019; 14 (12) 1763-1772
• 10 Gorrin MR, Teruel-Briones JL, Vion VB, Rexach L, Quereda C. Palliative peritoneal dialysis: implementation of a home care programme for terminal patients treated with peritoneal dialysis (PD). Nefrologia 2015; 35 (02) 146-149
• 11 Oliver MJ, Salenger P. Making assisted peritoneal dialysis a reality in the United States: a Canadian and American viewpoint. Clin J Am Soc Nephrol 2020; 15 (04) 566-568
• 12 Stack AG. Determinants of modality selection among incident US dialysis patients: results from a national study. J Am Soc Nephrol 2002; 13 (05) 1279-1287
• 13 Wallace EL, Rosner MH, Alscher MD. et al. Remote patient management for home dialysis patients. Kidney Int Rep 2017; 2 (06) 1009-1017
• 14 Finkelstein FO, Story K, Firanek C. et al. Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies. Kidney Int 2008; 74 (09) 1178-1184
• 15 Winterbottom A, Bekker H, Mooney A. Dialysis modality selection: physician guided or patient led?. Clin Kidney J 2016; 9 (06) 823-825
• 16 Ghaffari A, Kalantar-Zadeh K, Lee J, Maddux F, Moran J, Nissenson A. PD first: peritoneal dialysis as the default transition to dialysis therapy. Semin Dial 2013; 26 (06) 706-713
• 17 Teitelbaum I, Glickman J, Neu A. et al. KDOQI US commentary on the 2020 ISPD practice recommendations for prescribing high-quality goal-directed peritoneal dialysis. Am J Kidney Dis 2021; 77 (02) 157-171
• 18 Lan PG, Clayton PA, Johnson DW. et al. Duration of hemodialysis following peritoneal dialysis cessation in Australia and New Zealand: proposal for a standardized definition of technique failure. Perit Dial Int 2016; 36 (06) 623-630
• 19 Chidambaram M, Bargman JM, Quinn RR, Austin PC, Hux JE, Laupacis A. Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study. Perit Dial Int 2011; 31 (05) 565-573
• 20 See EJ, Johnson DW, Hawley CM. et al. Risk predictors and causes of technique failure within the first year of peritoneal dialysis: an Australia and New Zealand dialysis and transplant registry (ANZDATA) study. Am J Kidney Dis 2018; 72 (02) 188-197
• 21 Shen JI, Mitani AA, Saxena AB, Goldstein BA, Winkelmayer WC. Determinants of peritoneal dialysis technique failure in incident US patients. Perit Dial Int 2013; 33 (02) 155-166
• 22 Chui BK, Manns B, Pannu N. et al. Health care costs of peritoneal dialysis technique failure and dialysis modality switching. Am J Kidney Dis 2013; 61 (01) 104-111
• 23 Torres H, Naljayan M, Frontini M, Aguilar E, Barry S, Reisin E. Evaluating factors contributing to dropout in a large peritoneal dialysis program. Am J Med Sci 2021; 361 (01) 30-35
• 24 Oveyssi J, Manera KE, Baumgart A. et al. Patient and caregiver perspectives on burnout in peritoneal dialysis. Perit Dial Int 2021; 41 (05) 484-493
• 25 Mehrotra R, Soohoo M, Rivara MB. et al. Racial and ethnic disparities in use of and outcomes with home dialysis in the United States. J Am Soc Nephrol 2016; 27 (07) 2123-2134
• 26 Saran R, Robinson B, Abbott KC. et al. US Renal Data System 2016 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2017; 69 (03, Suppl 1): A7-A8
• 27 Ivarsen P, Povlsen JV. Can peritoneal dialysis be applied for unplanned initiation of chronic dialysis?. Nephrol Dial Transplant 2014; 29 (12) 2201-2206