Outcomes by Dialysis Modality in a Safety-Net Population

Key Points Peritoneal dialysis encourages active patient engagement. Peritoneal dialysis patients have higher transplant evaluation rates. Background In-center hemodialysis is delivered by dialysis providers, while peritoneal dialysis (PD) involves active patient engagement through self-care. This self-care process may be associated with potential collateral health benefits that can positively affect clinical and patient-centered outcomes. Kidney transplantation (KT) is the primary goal among kidney failure patients. Several studies have shown that PD patients are more likely to receive KT than hemodialysis patients; however, baseline socioeconomic differences may confound differences in receipt of KT. Furthermore, differences in KT among low-income dialysis recipients remain uncharacterized. In this retrospective study, we compared transplant evaluation and listing status among propensity-matched incident hemodialysis and PD patients within a large safety-net health system. Methods One hundred fifty adult PD patients who initiated at Parkland Health from January 2012 to December 2022 were propensity-matched 1:1 with hemodialysis patients based on age, race and ethnicity, language, and comorbidities. The primary outcome was the proportion of patients evaluated for transplantation. Secondary outcomes included the proportion of patients listed for transplantation, reasons for not listing, proportion transplanted, time to transplant, hospitalization rates, and mortality. Results Propensity score-matched hemodialysis and PD patients had similar age, distribution of sex, race and ethnicity, language preference, comorbidities, education, and insurance. Among patients initiated on PD, 129 (86.0%) were evaluated for KT, compared with 105 (70.0%) patients on hemodialysis ( P = 0.001). Furthermore, a significantly higher proportion of PD patients than hemodialysis patients were ultimately listed for transplantation (51.3% versus 31.3%, P < 0.001). Moreover, 26 (17.3%) hemodialysis patients and 33 (22.0%) PD patients underwent KT ( P = 0.309). The difference in kidney transplant among the two groups was not significant. Conclusions In this observational study of dialysis patients in a safety-net health system, we observed that more patients on PD were evaluated for transplant than those on hemodialysis, leading to higher KT listings of PD patients. These findings suggest that equitable implementation of PD can improve KT evaluation, even among underserved populations.