Table 1.
Characteristics of patients with incident ESKD in the United States, by Medicare prospective payment system policy period and early peritoneal dialysis experience
| Characteristic | Overall N=619,126 | Prepolicy Cohort: 2006–2010 N=387,115 | Postpolicy Cohort: 2011–2013 N=232,011 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| HD n=350,619 | PDa n=36,496 | HD n=202,837 | PDa n=29,174 | |||||||
| Cohort characteristics | ||||||||||
| Days observed, mean (SD) | 615 | (198) | 607 | (204) | 625 | (183) | 622 | (194) | 641 | (172) |
| Censored, N (%) | 244,833 | (40) | 145,418 | (42) | 18,589 | (51) | 69,641 | (34) | 11,235 | (39) |
| Patient characteristics | ||||||||||
| Age, mean (SD) | 61 | (16) | 61 | (15) | 55 | (17) | 61 | (15) | 55 | (16) |
| Male, N (%) | 353,727 | (57) | 199,025 | (57) | 20,479 | (56) | 117,419 | (58) | 16,804 | (58) |
| Race, N (%) | ||||||||||
| White | 396,992 | (64) | 220,586 | (63) | 26,101 | (72) | 129,824 | (64) | 20,481 | (70) |
| Black | 185,293 | (30) | 109,967 | (31) | 7953 | (22) | 60,855 | (30) | 6518 | (22) |
| Other | 36,841 | (6) | 20,066 | (6) | 2442 | (7) | 12,158 | (6) | 2175 | (8) |
| Hispanic ethnicity, N (%) | 87,414 | (14) | 48,649 | (14) | 4382 | (12) | 30,452 | (15) | 3931 | (14) |
| Employed (full- or part-time), N (%) | 77,597 | (13) | 38,433 | (11) | 10,143 | (28) | 20,962 | (10) | 8059 | (28) |
| Urban residential status, N (%) | 492,730 | (80) | 280,062 | (80) | 27,499 | (75) | 162,771 | (80) | 22,398 | (77) |
| Distance to nearest dialysis facility, mean miles (SD)b | 4 | (7) | 4 | (7) | 6 | (12) | 3 | (6) | 5 | (12) |
| Relative distance to nearest PD facility, mean miles (SD)b | 5 | (12) | 5 | (12) | 5 | (14) | 4 | (11) | 4 | (11) |
| Region, N (%) | ||||||||||
| South | 261,662 | (42) | 146,864 | (42) | 16,248 | (45) | 85,340 | (42) | 13,210 | (45) |
| Midwest | 133,346 | (22) | 76,494 | (22) | 7903 | (22) | 42,869 | (21) | 6080 | (21) |
| Northeast | 104,349 | (17) | 61,278 | (18) | 4850 | (13) | 34,754 | (17) | 3467 | (12) |
| West | 119,769 | (19) | 65,983 | (19) | 7495 | (21) | 39,874 | (20) | 6417 | (22) |
| Insurance, N (%)c | ||||||||||
| Medicare | 325,987 | (53) | 184,971 | (53) | 13,323 | (37) | 115,525 | (57) | 12,168 | (42) |
| Medicaid | 173,113 | (28) | 100,723 | (29) | 5909 | (16) | 61,600 | (30) | 4881 | (17) |
| Department of Veterans Affairs | 14,176 | (2) | 7764 | (2) | 512 | (1) | 5411 | (3) | 489 | (2) |
| Employer group | 164,044 | (27) | 91,041 | (26) | 16,747 | (46) | 44,232 | (22) | 12,024 | (41) |
| Other | 121,901 | (20) | 72,005 | (21) | 6963 | (19) | 37,840 | (19) | 5093 | (18) |
| None | 55,415 | (9) | 31,739 | (9) | 3270 | (9) | 17,519 | (9) | 2887 | (10) |
| Cause of ESKD, N (%) | ||||||||||
| Diabetes | 289,664 | (47) | 165,317 | (47) | 14,928 | (41) | 97,049 | (48) | 12,370 | (42) |
| Hypertension | 179,257 | (29) | 101,296 | (29) | 8762 | (24) | 61,497 | (30) | 7702 | (26) |
| GN | 56,086 | (9) | 29,656 | (9) | 6259 | (17) | 15,501 | (8) | 4670 | (16) |
| Other/Missing | 94,119 | (15) | 54,350 | (16) | 6547 | (18) | 28790 | (14) | 4432 | (15) |
| Unknown | ||||||||||
| Comorbidities, N (%)d | ||||||||||
| Hypertension | 538,007 | (87) | 301,935 | (86) | 31,457 | (86) | 178,880 | (88) | 25,735 | (88) |
| Diabetes | 341,783 | (55) | 193,327 | (55) | 16,730 | (46) | 117,329 | (58) | 14,397 | (49) |
| Congestive heart failure | 185,094 | (30) | 113,070 | (32) | 6331 | (17) | 60,985 | (30) | 4708 | (16) |
| Atherosclerotic heart disease | 114,870 | (19) | 71,700 | (20) | 5252 | (14) | 34,577 | (17) | 3341 | (12) |
| Peripheral vascular disease | 75,976 | (12) | 47,210 | (14) | 3232 | (9) | 23,456 | (12) | 2078 | (7) |
| Pre-ESKD nephrology care, N (%) | ||||||||||
| Yes | 375,642 | (61) | 201,886 | (58) | 29,641 | (81) | 120,448 | (59) | 23,667 | (81) |
| No | 171,393 | (28) | 106,635 | (30) | 5001 | (14) | 55,766 | (28) | 3991 | (14) |
| Unknown | 72,091 | (12) | 42,098 | (12) | 1854 | (5) | 26,623 | (13) | 1516 | (5) |
| BMI, kg/m2, mean (SD) | 29 | (8) | 29 | (8) | 29 | (7) | 30 | (8) | 29 | (7) |
| eGFR, ml/min per 1.73 m2, mean (SD)e | 10 | (6) | 10 | (6) | 10 | (5) | 10 | (6) | 10 | (5) |
| Market characteristics (hospital referral region) | ||||||||||
| Dialysis facility composition, mean (SD) | ||||||||||
| % offering PD in 2006f | 39 | (15) | 38 | (15) | 40 | (16) | 41 | (15) | 43 | (15) |
| % freestanding facilities | 90 | (15) | 89 | (16) | 90 | (15) | 91 | (13) | 92 | (12) |
| % for profit | 82 | (20) | 81 | (20) | 82 | (21) | 85 | (18) | 85 | (18) |
| % chain-affiliated | 85 | (16) | 83 | (17) | 84 | (17) | 86 | (15) | 88 | (13) |
| % urban location | 77 | (24) | 77 | (24) | 74 | (24) | 78 | (23) | 75 | (24) |
| Dialysis market competition, mean (SD)g | 39 | (18) | 39 | (18) | 41 | (19) | 39 | (18) | 41 | (18) |
| Hospital density, mean (SD)h | 301 | (117) | 306 | (121) | 303 | (112) | 293 | (113) | 290 | (107) |
| % urban general population, mean (SD) | 81 | (16) | 81 | (16) | 78 | (16) | 81 | (16) | 79 | (16) |
| Per capita income, $1000s, mean (SD) | 40 | (99) | 39 | (8) | 38 | (8) | 43 | (9) | 42 | (9) |
HD, hemodialysis; PD, peritoneal dialysis; BMI, body mass index; GN, glomerulonephritis.
PD modality at any point during the 2-yr follow-up period.
Absolute distance to nearest dialysis facility and relative distance (difference) between distance to nearest dialysis facility and distance to nearest dialysis facility that offers PD.
Insurance status is not mutually exclusive. Patients can have multiple sources of insurance coverage.
Other comorbidities included chronic obstructive pulmonary disease, cerebrovascular disease, inability to ambulate, inability to transfer, other cardiac disease, cancer, drug dependence, and tobacco use, not shown here but described in Supplemental Table 1.
Calculation of eGFR is on the basis of the Chronic Kidney Disease Epidemiology Collaboration formula.
PD includes continuous ambulatory PD, continuous cyclic PD, and other PD.
Measured using the Herfindahl–Hirschman index of dialysis market competition. Higher values correspond to less competition, i.e., more monopolistic markets.
Hospital density is defined as the number of community hospital beds per 100,000 people in a hospital referral region.