Geographical Variation in Peritoneal Dialysis Catheter Insertion and Initiation within the United States.

ABSTRACT: Peritoneal dialysis (PD) is an effective but underutilized renal replacement therapy modality. There are limited data regarding geographical variation in PD catheter insertion and utilization of PD as a first renal replacement therapy in the United States. We explored the variation in catheter insertion and initiation of PD utilizing 2 large, nationally representative databases. The incidence of catheter insertion differed significantly by geographical region, being highest in the South (7.30/100 end-stage renal disease [ESRD] patients; 95% confidence [CI] interval 6.78 - 7.81) and lowest in the West (5.91/100 ESRD patients; 95% CI 5.43 - 6.38). Peritoneal dialysis initiation also differed by region, being highest in the West (7.10/100 ESRD patients; 95% CI 6.83 - 7.30) and lowest in the Northeast (5.12/100 ESRD patients; 95% CI 4.87 - 5.30). Interestingly, the Northeast region, with the lowest rate of PD utilization, had the highest number of nephrologists per population (3.95/100,000 persons), and the West, with the highest PD utilization, had the lowest number of nephrologists (2.54/100,000 persons). Reasons for this variation should be explored further and efforts should be made to standardize PD implementation throughout the United States.

SUBMITTER: Patel A 

PROVIDER: S-EPMC5174880 | biostudies-literature | 2016 11-12

REPOSITORIES: biostudies-literature