Geographical variation in peritoneal dialysis catheter insertion and initiation within the United States

Peritoneal dialysis (PD) is an effective but underutilized renal replacement therapy modality. There are limited data regarding geographical variation in PD catheter insertion and utilization of PD as a first renal replacement therapy in the United States. We explored the variation in catheter insertion and initiation of PD utilizing 2 large, nationally representative databases. The incidence of catheter insertion differed significantly by geographical region, being highest in the South (7.30/100 end-stage renal disease [ESRD] patients; 95% confidence [CI] interval 6.78-7.81) and lowest in the West (5.91/100 ESRD patients; 95% CI 5.43-6.38). Peritoneal dialysis initiation also differed by region, being highest in the West (7.10/100 ESRD patients; 95% CI 6.83-7.30) and lowest in the Northeast (5.12/100 ESRD patients; 95% CI 4.87-5.30). Interestingly, the Northeast region, with the lowest rate of PD utilization, had the highest number of nephrologists per population (3.95/100,000 persons), and the West, with the highest PD utilization, had the lowest number of nephrologists (2.54/100,000 persons). Reasons for this variation should be explored further and efforts should be made to standardize PD implementation throughout the United States.