Current Modalities for Treating Adult Patients with ESRD from 2018-2024 Using IPRO Data

Background: While in-center hemodialysis (HD) remains the predominant initial therapy, there has been a gradual shift toward home-based modalities such as peritoneal dialysis (PD) and home HD. Kidney transplantation rates have also risen, reflecting national efforts to improve long-term outcomes. This study aims to examine the current trends and distribution of dialysis (urban vs rural) and transplant modalities among U.S. adults with ESRD, recognizing that available USRDS data typically lag by approximately three years. Methods: We analyzed data from 252,075 patients across the New England, New York, South Atlantic, and Ohio River regions enrolled between 2018 and 2024. Descriptive statistics summarized demographic and clinical features, while Cox regression evaluated the effects of age, gender, race, and location on treatment outcomes. Results: Between 2018 and 2024, 86% of patients with ESRD initiated in-center hemodialysis, while only 11% began with peritoneal dialysis (PD). The median age was 65 years (range 18–105), and 58% were male. Most patients (86%) received treatment in urban settings. Transition from HD to PD increased modestly over time (4.2% after year 1 vs. 6.5% after year 5). Only 3% were placed on a preemptive transplant list, and pre-dialysis transplants were rare (0.09%). At five years, 16.2% had received a kidney transplant. Conclusion: In-center HD remains the primary initial therapy, particularly in urban areas, likely reflecting limited rural access. Despite modest increases in PD use, home modalities and preemptive transplants are still underutilized. Reducing geographic disparities, improving patient education, and promoting early transplant listing are essential to advancing equitable ESRD care.