Outcomes by Dialysis Modality in a Safety-Net Population: A 10-Year Retrospective Cohort Study.

Background: In-center hemodialysis (HD) 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 impact clinical and patient-centered outcomes. Kidney transplantation (KT) is the primary goal among kidney failure (KF) patients. Several studies have shown that PD patients are more likely to receive KT than HD 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 HD and PD patients within a large safety-net health system.

Methods: 150 adult PD patients who initiated at Parkland Health from January 2012 to December 2022 were propensity-matched 1:1 with HD patients based on age, race/ethnicity, language, and co-morbidities. 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 HD and PD patients had similar age, distribution of gender, race/ethnicity, language preference, co-morbidities, education, and insurance. Among patients initiated on PD, 129 (86.0%) were evaluated for KT, compared to 105 (70.0%) patients on HD (p=0.001). Furthermore, a significantly higher proportion of PD patients than HD patients were ultimately listed for transplantation (51.3% vs. 31.3%, p<0.001). Moreover, 26 (17.3%) HD 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 HD, leading to higher KT listings of PD patients. These findings suggest that equitable implementation of PD can improve KT evaluation, even among underserved populations.