The Association between Prevalence of Peritoneal Dialysis versus Hemodialysis and Patients' Distance to Dialysis-Providing Facilities

Background Accessibility to dialysis facilities plays a central role when deciding on a patient's long-term dialysis modality. Studies investigating the effect of distance to nearest dialysis-providing unit on modality choice have yielded conflicting results. We set out to investigate the association between patients' dialysis modality and both the driving and straight-line distances to the closest HD-and PD-providing units. Methods All patients with ESKD who initiated in-center HD and PD in 2017, were 18-90 years old, and were on dialysis for >= 30 days were included. Patients in residence zip codes in nonconterminous United States or lived > 90 miles from the nearest HD-providing unit were excluded. Results A total of 102,247 patients in the United States initiated in-center HD and PD in 2017. Compared with patients on HD, patients on PD had longer driving distances to their nearest PD unit (4.4 versus 3.4 miles; P < 0.001). Patients who lived > 30 miles from the nearest HD unit were more likely to be on PD if the nearest PD unit was a distance equal to/less than that of the HD unit. PD utilization increased with increasing distance from patients' homes to the nearest HD unit. No change in this association was found regardless of if the PD unit was farther from/closer than the nearest HD unit. This association was not seen with straight-line distance analysis. Conclusions With increasing distances from the nearest dialysis-providing units (HD or PD), PD utilization increased. Using driving distance rather than straight-line distance affects data analysis and outcomes. Increasing the number of PD units may have a limited effect on increasing PD utilization.