Effect of End-Stage Renal Disease Prospective Payment System on Utilization of Peritoneal Dialysis in Patients with Kidney Allograft Failure.

INTRODUCTION: The Center for Medicare and Medicaid Services (CMS) introduced an End Stage Renal Disease (ESRD) Prospective Payment System (PPS) in 2011 to increase the utilization of home dialysis modalities, including peritoneal dialysis (PD). Several studies have shown a significant increase in PD utilization after PPS implementation. However, its impact on patients with kidney allograft failure remains unknown.

METHODS: We conducted an interrupted time series (ITS) analysis using data from the United States Renal Data System (USRDS) that include all adult kidney transplant recipients with allograft failure who started dialysis between 2005 and 2019. We compared the PD utilization in the pre-PPS period (2005-2010) to the fully implemented post-PPS period (2014 - 2019) for early (within 90 days) and late (91-365 days) PD experience.

RESULTS: 27507 adult recipients with allograft failure started dialysis during the study period. There was no difference in early PD utilization between the pre-PPS and the post-PPS period in either immediate change (0.3% increase; 95%CI: -1.95%, 2.54%; p=0.79) or rate of change over time (0.28% increase per year; 95%CI: -0.16%, 0.72%; p=0.18). Subgroup analyses revealed a trend toward higher PD utilization post-PPS in for-profit and large-volume dialysis units. There was a significant increase in PD utilization in the post-PPS period in units with low PD experience in the pre-PPS period. Similar findings were seen for the late PD experience.

CONCLUSION: PPS did not significantly increase the overall utilization of PD in patients initiating dialysis after allograft failure.