title: Neighborhood location, rurality, geography, and outcomes of peritoneal dialysis patients in the United States.
abstract: BACKGROUND
  The adjusted 5-year survival for dialysis patients in the United States is 33%-35%, and patients treated with peritoneal dialysis (PD) have a high risk of transfer to hemodialysis (HD). No data are available on the effect of neighborhood characteristics or regional differences on the outcomes of PD patients in the United States.
  
  
  METHODS
  We analyzed the relationships of selected patient demographics, socio-economic characteristics of the dialysis unit's neighborhood, "rurality," and geographic location with transfer to HD and with a composite outcome of transfer to HD or death, for all PD patients in the United States who, between 2004 and 2009, used supplies manufactured by Baxter Healthcare (n = 58 700).
  
  
  RESULTS
  Over a median follow-up of 18.7 months, 29% of patients transferred to HD (median time to HD transfer: 49 months), and 54% reached the composite outcome. More than 20% of the events occurred within the first 90 days of PD start. The risk for each of the study outcomes was higher for patients who had received any previous treatment with HD, for those treated in units located in areas with a higher proportion of black residents, and for those living in remote rural areas. Furthermore, the risk for reaching either of the study outcomes was consistently lower for patients treated in units located in California, Alaska, Hawaii, Guam, the Mariana Islands, and American Samoa.
  
  
  CONCLUSIONS
  We observed significant regional differences in the outcomes of PD patients in the United States that have not previously been reported. Understanding the differences in clinical practice that underlie these regional differences might help to further improve PD outcomes.
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA. rmehrotra@labiomed.org
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Kenneth
authors.initials: K
authors.lastname: Story
authors.forename: Steven
authors.initials: S
authors.lastname: Guest
authors.forename: Michelle
authors.initials: M
authors.lastname: Fedunyszyn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality; D006435:Renal Dialysis; D012111:Residence Characteristics; D012423:Rural Health; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult