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Health Insurance and the Use of Peritoneal Dialysis in the United States.

ABSTRACT: BACKGROUND:Many patients in the United States have limited or no health insurance at the time they develop end-stage renal disease (ESRD). We examined whether health insurance limitations affected the likelihood of peritoneal dialysis (PD) use. STUDY DESIGN:Retrospective cohort analysis of patients from the US Renal Data System initiating dialysis therapy in 2006 through 2012. SETTING & PARTICIPANTS:We identified socioeconomically similar groups of patients to examine the association between health insurance and PD use. Patients aged 60 to 64 years with "limited insurance" (defined as having Medicaid or no insurance) at ESRD onset were compared with patients aged 66 to 70 years who were dually eligible for Medicare and Medicaid at ESRD onset. PREDICTOR:Type of insurance coverage at ESRD onset. OUTCOMES:The likelihoods of receiving PD before dialysis month 4, when all patients qualified for Medicare due to ESRD, and of switching to PD therapy following receipt of Medicare. RESULTS:After adjusting for observable patient and geographic differences, patients with limited insurance had an absolute 2.4% (95% CI, 1.1%-3.7%) lower probability of PD use by dialysis month 4 compared with patients with Medicare at ESRD onset. The association between insurance and PD use reversed when patients became Medicare eligible; patients with limited insurance had a 3-fold higher rate of switching to PD therapy between months 4 and 12 of dialysis (HR, 2.9; 95% CI, 1.8-4.6) compared with patients with Medicare at ESRD onset. LIMITATIONS:Because this study was observational, there is a potential for bias from unmeasured patient-level factors. CONCLUSIONS:Despite Medicare's policy of covering patients in the month that they initiate PD therapy, insurance limitations remain a barrier to PD use for many patients. Educating providers about Medicare reimbursement policy and expanding access to pre-ESRD education and training may help overcome these barriers.

SUBMITTER: Perez JJ

PROVIDER: S-EPMC6502758 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Health Insurance and the Use of Peritoneal Dialysis in the United States.

Perez Jose J JJ Zhao Bo B Qureshi Samaya S Winkelmayer Wolfgang C WC Erickson Kevin F KF

American journal of kidney diseases : the official journal of the National Kidney Foundation 20171223 4

<h4>Background</h4>Many patients in the United States have limited or no health insurance at the time they develop end-stage renal disease (ESRD). We examined whether health insurance limitations affected the likelihood of peritoneal dialysis (PD) use.<h4>Study design</h4>Retrospective cohort analysis of patients from the US Renal Data System initiating dialysis therapy in 2006 through 2012.<h4>Setting & participants</h4>We identified socioeconomically similar groups of patients to examine the a ...[more]

PMID: 29277511

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Project description:BackgroundPeople with end-stage kidney disease receiving peritoneal dialysis (PD) are generally physically inactive and frail. Exercise studies in PD are scarce and currently there are no PD exercise programs in the United States. The primary objective of this study was to test the feasibility of a combined resistance and cardiovascular exercise program for PD patients under the care of a dedicated home dialysis center in the United States.Study designParallel randomized controlled feasibility study.Setting & participantsPD patients were recruited from a single center and randomly assigned to the intervention (exercise; n = 18) or control (nonexercise; n = 18) group.InterventionThe intervention group received monthly exercise physiologist consultation, exercise prescription (resistance and aerobic exercise program using exercise bands), and 4 exercise support telephone calls over 12 weeks. The control group received standard care.OutcomesThe primary outcome was study feasibility as measured by eligibility rates, recruitment rates, retention rates, adherence rates, adverse events, and sustained exercise rates. Secondary outcome measures were changes in physical function (sit-to-stand test, timed-up-and-go test, and pinch-strength tests) and patient-reported outcome measures.ResultsFrom a single center with 75 PD patients, 57 (76%) were deemed eligible, resulting in a recruitment rate of 36 (63%) patients. Participants were randomly assigned into 2 groups of 18 (1:1). 10 patients discontinued the study (5 in each arm), resulting in 26 (72%) patients, 13 in each arm, completing the study. 10 of 13 (77%) intervention patients were adherent to the exercise program. A t test analysis of covariance found a difference between the treatment groups for the timed-up-and-go test (P = 0.04) and appetite (P = 0.04). No serious adverse events caused by the exercise program were reported.LimitationsSingle center, no blinded assessors.ConclusionsA resistance and cardiovascular exercise program appears feasible and safe for PD patients. We recommend that providers of PD therapy consider including exercise programs coordinated by exercise professionals to reduce the physical deterioration of PD patients.FundingNone.Trial registrationNCT03980795.

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Health Insurance and the Use of Peritoneal Dialysis in the United States.

Publications

Health Insurance and the Use of Peritoneal Dialysis in the United States.

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