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CHANGING PATTERNS OF PERITONEAL DIALYSIS UTILIZATION IN THE UNITED STATES

Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, and David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, U.S.A.

Correspondence to: R. Mehrotra, 1124 W. Carson Street, Torrance, California 90502 U.S.A.
rmehrotra{at}labiomed.org

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.

KEY WORDS: KEY WORDS:; End-stage renal disease; chronic kidney disease; hemodialysis; initiation of dialysis.

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