The association between prevalence of peritoneal dialysis vs hemodialysis and patients' distance to dialysis-providing facilities

Background: Accessibility to dialysis facilities plays a central role when deciding on a patient9s long-term dialysis modality. Studies investigating the effect of distance to nearest dialysis-providing unit on modality choice have yielded conflicting results. We set out to investigate the association between patients9 dialysis modality and both the driving and straight-line distances to the closest HD- and PD-providing units. Methods: All end stage kidney disease patients who initiated in-center HD and PD in 2017, 18-90 years old, and on dialysis for ≥30 days were included. Patients in residence zip codes in non-conterminous United States or lived >90 miles from the nearest HD-providing unit were excluded. Results: 102,247 patients in the United States initiated in-center HD and PD in 2017. Compared to HD patients, PD patients had longer driving distances to their nearest PD unit (4.4 vs 3.4 miles; p 30 miles from the nearest HD unit were more likely to be on PD if the nearest PD unit was a distance equal to/less than the HD unit. PD utilization increased with increasing distance from patients9 homes to the nearest HD unit. No change in this association was found regardless of if the PD unit was farther/closer than the nearest HD unit. This association was not seen with straight line distance analysis. Conclusions: With increasing distances from the nearest dialysis providing units (HD or PD), PD utilization increased. Using driving distance rather than straight line distance affects data analysis and outcomes. Increasing the number of PD units may have a limited impact on increasing PD utilization.