Peritoneal Dialysis Outpacing Home Hemodialysis

Trend started around the introduction of the Medicare prospective payment system for dialysis care.
Trend started around the introduction of the Medicare prospective payment system for dialysis care.

SEATTLE—The number of patients on home hemodialysis (HHD) grew rapidly while the number of those on peritoneal dialysis (PD) grew slowly in the United States prior to the debut of the Medicare prospective payment system for dialysis care in 2011, but the pattern subsequently reversed, according to data presented at the 2016 Annual Dialysis Conference.

Possible explanations for the trend include a higher profit margin potentially associated with PD and lack of adequate reimbursement for HHD training, said Eric D. Weinhandl, PhD, MS, who presented study findings. Under the prospective payment system (PPS), PD is reimbursed at the same rate as in-center HD (3 sessions per week), Dr. Weinhandl told attendees. “So there certainly is the potential for added profit margin with peritoneal dialysis,” he said.

Another reason may be the combined effect of increased acceptance of starting patients on PD and a PPS onset of dialysis adjustment during the first 120 days of dialysis, which had increased the base pay for PD by 51% from 2011 to 2015, he explained. “These forces come together, and they certainly provide a lot of impetus for peritoneal dialysis growth,” he said.

Dr. Weinhandl and Allan J. Collins, MD, both from the University of Minnesota in Minneapolis, estimated annual growth rates of HHD and PD patient counts from 2004 to 2014 across end-stage renal disease (ESRD) networks. They used data from the ESRD Network Organization Programs Summary Annual Reports for 2004–2012 and individual ESRD Network Annual Reports for 2013 and 2014.

The number of HHD patients in the United States increased from 1,529 in 2004 to 5,844 in 2010 (an increase of 282%) and 8,080 in 2014, an increase of 428% compared with 2004. The number of PD patients increased from 26,710 in 2004 to 31,867 in 2010 (an increase of 19%) and 45,247 in 2014 (an increase of 69% compared with 2004). Among HHD patients, the annual growth rate was 24.9% in 2004–2010; this decreased to 7.9% in 2010 – 2014. In contrast, among PD patients, the annual growth rate was 2.8% in 2004–2010; this increased to 10.1% in 2010–2014.

Additionally, in 2004–2010, the study showed that the HHD annual growth rates ranged from 12.5% to 41.8% across ESRD networks; in 2010–2014, the change in growth rates ranged from a decline of 2.5% to an increase of 18%. Among PD patients, growth rates ranged from a decline of 1.5% to an increase of 6.2% across ESRD networks in 2004–2010; in 2010–2014, the rates ranged from an increase of 3.7% to 14%.

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