title: Geographic and temporal trends in peritoneal dialysis services in the United States between 1995 and 2003.
abstract: BACKGROUND
  Peritoneal dialysis (PD) is the preferred dialysis modality for many patients with end-stage renal disease (ESRD) in the United States. However, in sharp contrast to the high rates of PD use in other industrialized countries, PD use in the United States is low and decreasing. PD availability is a necessary condition for PD use; however, little is known about the availability and geographic distribution of PD services. This study describes trends in the regional supply of PD services in dialysis facilities between 1995 and 2003.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Nonfederal outpatient dialysis facilities treating patients with ESRD in the United States using data from the US Renal Data System.
  
  
  METHODS
  Annual ESRD patient and dialysis facility composition in hospital referral regions.
  
  
  RESULTS
  Annual proportion of dialysis facilities offering PD treatment services in hospital referral regions.
  
  
  RESULTS
  The average proportion of facilities offering PD services in hospital referral regions was 56% in 1996, which decreased to 47% in 2003. There was geographic variation in PD services, with greater PD availability in metropolitan cities (compared with rural regions) and the Northeast (relative to the South and Midwest). Variation in PD availability was not explained by disease trends or patient characteristics believed to be important for PD use. An increasing regional presence of chain-affiliated facilities was associated with less PD supply.
  
  
  CONCLUSIONS
  Accuracy of patient registry data, inability to account for consolidation of PD services among chain providers, sensitivity of results to definition of regional markets.
  
  
  CONCLUSIONS
  The small and decreasing availability of PD therapy seems counterintuitive given its demonstrated appeal to patients and payers. Further research is needed to investigate dialysis facilities' role in the underuse of a potentially useful therapy.
authors.affiliation: Health Services Research and Development, Durham VA Medical Center, Durham, NC 27705, USA. virginia.wang@duke.edu
authors.forename: Virginia
authors.initials: V
authors.lastname: Wang
authors.forename: Shoou-Yih D
authors.initials: SY
authors.lastname: Lee
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Ricketts
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
mesh_terms: D015331:Cohort Studies; D006297:Health Services Accessibility / Q000639:trends; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D008137:Longitudinal Studies; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data* / Q000639:trends*; D044469:Racial Groups; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
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