Changing patterns of peritoneal dialysis utilization in the United States.

The proportion of incident U.S. patients with end-stage renal disease starting chronic peritoneal dialysis (CPD) has historically been low. The low take-on for CPD in the United States is likely multifactorial, but limited physician training and inadequate pre-dialysis patient education appear to be particularly important. Furthermore, two key changes have occurred in the United States: a steep decline in CPD take-on and a progressive increase in the use of automated peritoneal dialysis (APD). The decline in CPD take-on has affected virtually every subgroup examined and has occurred, paradoxically, when the CPD outcomes in the country have improved. Understanding the reasons for historically low CPD take-on and recent steep declines in utilization may allow for plans to reverse these trends to be developed.