Insurance Type Affects Initial Dialysis Modality Choice

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Patients on Medicaid are less likely to initiate peritoneal dialysis.
Patients on Medicaid are less likely to initiate peritoneal dialysis.

ORLANDO, Fla.—Patients with end-stage renal disease (ESRD) on dialysis are less likely to initiate peritoneal dialysis (PD) if they have no insurance or are on Medicaid, according to study findings presented at the National Kidney Foundation's 2017 Spring Clinical Meetings. Once on Medicare, patients on hemodialysis (HD) are more likely to transition to PD.

“The nephrology community needs to be aware of this association and can hopefully improve the use of PD,” Samaya Qureshi, MD, and colleagues at Baylor College of Medicine in Houston, concluded in a poster presentation.

According to the investigators, removing barriers to PD use may involve expanding coverage for PD education; educating providers and patients about different dialysis modalities and policies related to dialysis initiation that may affect their kidney replacement modality choice; and educating providers specifically about Medicare reimbursement policies for PD.

Dr Qureshi and colleagues conducted a retrospective cohort analysis using the U.S. Renal Data System registry. They compared PD use among 7258 patients aged 60–64 years with limited insurance (no insurance or Medicaid and in Medicare's 3-month waiting period) and among 8815 patients aged 66–70 years with Medicare and Medicaid. They examined the association between insurance coverage at the start of dialysis and the likelihood of assignment to PD within the first 3 months of starting dialysis and the likelihood of switching from in-center HD to PD after 3 months.

Among patients with Medicare, 4% used PD within their first 3 months of dialysis compared with only 2.2% among patients with limited insurance. Patients with limited insurance were 54% less likely to receive PD in their first 3 months of dialysis, after adjusting for patient and geographic differences.

When the investigators examined the rate of switching to PD after 3 months of dialysis—when all patients became eligible for Medicare—the association between insurance and PD use reverse, the investigators reported.

Among patients receiving ICHD at the start of their 4th month of dialysis, patients from the limited insurance group had a 3-fold greater rate of switching to PD during the remainder of their first year of dialysis compared with patients on Medicare at the onset of ESRD.

See more coverage from the National Kidney Foundation Spring Clinical meeting.

Reference

Qureshi S, Perez J, Zhao B, et al. Health insurance and peritoneal dialysis use in the United States. Poster presented at the National Kidney Foundation's 2017 Spring Clinical Meeting in Orlando, Florida. Poster 299.

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