title: Geographical Variation in Peritoneal Dialysis Catheter Insertion and Initiation within the United States.
abstract: Peritoneal dialysis (PD) is an effective but underutilized renal replacement therapy modality. There are limited data regarding geographical variation in PD catheter insertion and utilization of PD as a first renal replacement therapy in the United States. We explored the variation in catheter insertion and initiation of PD utilizing 2 large, nationally representative databases. The incidence of catheter insertion differed significantly by geographical region, being highest in the South (7.30/100 end-stage renal disease [ESRD] patients; 95% confidence [CI] interval 6.78 - 7.81) and lowest in the West (5.91/100 ESRD patients; 95% CI 5.43 - 6.38). Peritoneal dialysis initiation also differed by region, being highest in the West (7.10/100 ESRD patients; 95% CI 6.83 - 7.30) and lowest in the Northeast (5.12/100 ESRD patients; 95% CI 4.87 - 5.30). Interestingly, the Northeast region, with the lowest rate of PD utilization, had the highest number of nephrologists per population (3.95/100,000 persons), and the West, with the highest PD utilization, had the lowest number of nephrologists (2.54/100,000 persons). Reasons for this variation should be explored further and efforts should be made to standardize PD implementation throughout the United States.
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Medicine, Detroit Medical Center, Detroit, MI, USA.
authors.forename: Harshil
authors.initials: H
authors.lastname: Shah
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Shanti
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA girish.nadkarni@mountsinai.org.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Uribarri
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002404:Catheterization / Q000379:methods* / Q000706:statistics & numerical data; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014481:United States
keywords: Peritoneal dialysis; catheter; geographical variation