Retention on Peritoneal Dialysis (PD): Adult Patients Transition Away from PD, a Five-Year Regional Analysis Using IPRO Data

Background: We are particularly interested in the retention of patients who initiated PD, given the 2019 Executive Order by the Department of Health and Human Services promoted home-based therapies. While the percentage of patients receiving peritoneal dialysis (PD) has gradually increased, in-center hemodialysis (HD) still dominates, accounting for 82.4% of dialysis patients. This study explores the transition of patients from PD to other modalities over a 5 year period. Methods: We analyzed data from 250,447 adult patients across the New England, New York, South Atlantic, and Ohio River regions from 2018 to 2024. Descriptive statistics used median (range) for quantitative and frequency (percentage) for qualitative variables. Results: Of the patient population, 15.3% were on PD (incident PD & PD after HD). The rate of PD retention declined sharply: only 7.8% of PD patients remained on PD after five years. Survival rate was highest in the first year (91.8%), correlating with the lowest failure rate (14.3%). As time progressed, the survival rate decreased to 48.7% in year 5, with the failure rate increasing to 68.9%. These trends were consistent across all four studied regions. Most influential factors for PD failure were patient age and urban vs rural treatment location (p< 0.0001). Conclusion: Although PD offers quality-of-life advantages over HD, its long-term adoption remains low due to significant early failure rates and other persistent barriers, such as healthcare illiteracy, appropriate home environment, and inadequate support. Further research is essential to identify and develop policies to help mitigate the multifaceted challenges preventing sustained use of PD in clinical practice.