Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Am J Nephrol. 2024;55(5):551-560. doi: 10.1159/000539062. Epub 2024 May 16.
The Center for Medicare and Medicaid Services introduced an End-Stage Renal Disease 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.
We conducted an interrupted time series analysis using data from the US 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.
A total of 27,507 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.
PPS did not significantly increase the overall utilization of PD in patients initiating dialysis after allograft failure.
为了增加包括腹膜透析（PD）在内的家庭透析模式的使用率，医疗保险和医疗补助服务中心（CMS）于 2011 年推出了终末期肾脏病预付制（PPS）。几项研究表明，PPS 实施后 PD 的使用率显著增加。然而，其对移植肾失功患者的影响尚不清楚。
我们使用美国肾脏数据系统（USRDS）的数据进行了一项中断时间序列分析，这些数据包括 2005 年至 2019 年期间所有开始透析的移植肾失功的成年肾移植受者。我们比较了 PPS 前（2005-2010 年）和完全实施后的 PPS 后（2014-2019 年）早期（90 天内）和晚期（91-365 天）PD 经历的 PD 使用率。
研究期间共有 27507 名移植肾失功的成年受者开始透析。在即刻变化（增加 0.3%；95%CI：-1.95%，2.54%；p=0.79）或随时间变化的速率（每年增加 0.28%；95%CI：-0.16%，0.72%；p=0.18）方面，PPS 前和 PPS 后早期 PD 使用率无差异。亚组分析显示，在盈利性和大容量透析单位中，PPS 后 PD 使用率呈上升趋势。在 PPS 前 PD 经验较低的单位中，PPS 后 PD 使用率显著增加。晚期 PD 经历也有类似的发现。
PPS 并未显著增加移植肾失功后开始透析患者 PD 的总体使用率。
