title: Underutilization of peritoneal dialysis: the role of the nephrologist's referral pattern.
abstract: BACKGROUND
  The incidence of end-stage renal disease is increasing, placing a tremendous burden on health care resources. Peritoneal dialysis (PD) is cheaper than hemodialysis and has many potential advantages and few contraindications as an initial modality selection. This study examined differences in patient PD attempt rates between nephrologists using technique survival and mortality as outcomes.
  
  
  METHODS
  We performed a retrospective review of the Manitoba Renal Program databases from January 2004 to January 2010. Analysis of 630 patients who commenced dialysis and had demographic data available was performed. A genetic matching algorithm was used to balance potential differences between patient characteristics. Each nephrologist was then compared against their peers to calculate a PD attempt rate. The highest attempt rate group was compared with the lowest.
  
  
  RESULTS
  When comparing PD attempt rates between groups, all the results were significant. PD technique survival at >90 days showed no significant differences (P = 0.42). Patient mortality at >90 days was also not significant when comparing groups (P = 0.14).
  
  
  CONCLUSIONS
  Our data suggest that when comparing the low- with high-attempt groups, the factors limiting PD utilization do not include on-site availability of PD, case mix, funding, patient location or reimbursement. Aggressive approaches of starting more patients on PD did not lead to lower technique survival or higher mortality rates. If the PD attempt rate was maximized, a significant amount of money and resources could be saved or directed toward helping a larger population without significant harm to patients.
authors.affiliation: Department of Medicine, University ofManitoba, Winnipeg, Canada.
authors.forename: Jay
authors.initials: J
authors.lastname: Hingwala
authors.forename: Jeff
authors.initials: J
authors.lastname: Diamond
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.forename: Joe
authors.initials: J
authors.lastname: Bueti
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Mauro
authors.initials: M
authors.lastname: Verrelli
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
mesh_terms: D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008350:Manitoba; D009398:Nephrology; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate