Changing patterns of peritoneal dialysis utilization in the United States.
The proportion of incident U.S. patients with end-stage renal disease starting chronic peritoneal dialysis (CPD) has historically been low. The low take-on for CPD in the United States is likely multifactorial, but limited physician training and inadequate pre-dialysis patient education appear to be particularly important. Furthermore, two key changes have occurred in the United States: a steep decline in CPD take-on and a progressive increase in the use of automated peritoneal dialysis (APD). The decline in CPD take-on has affected virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow for plans to reverse these trends to be developed.
Mehrotra
Rajnish
R
Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, and David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90502, USA. rmehrotra@labiomed.org
D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D009398:Nephrology / Q000193:education; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology