The Effect of Nephologist Affiliation on PD Utilization for Patients With ESKD

Key Takeaways:

• For patients with end-stage kidney disease (ESKD), peritoneal dialysis (PD) was slightly more common among those whose nephrologist was affiliated with a dialysis facility as opposed to those whose nephrologist was nonaffiliated.
• PD catheter placement occurred more among patients whose nephrologists were affiliated with for-profit facilities or facilities that offered PD as a treatment option.

Dialysis is one of the most common treatment methods for patients with ESKD. Home-based PD specifically has been shown to be an effective and preferred treatment option, yet it remains underutilized in the US. This study analyzed how nephrologists’ affiliations with dialysis facilities influence the promotion of PD catheter placement in patients with ESKD.

This retrospective study assessed Medicare patients who began dialysis between 2013 and 2022 and determined the number of PD catheter placements that occurred within 24 months after dialysis initiation.

Study Findings

Out of a sample size of 28 040 patients with ESKD receiving dialysis, 24 301 (86.7%) had a nephrologist affiliated with a dialysis facility, and 3739 (13.3%) had a nephrologist who was not affiliated with a dialysis facility.

The adjusted 24-month percentage of PD catheter placement was higher among patients with an affiliated nephrologist than a nonaffiliated nephrologist (9.9% vs 8.2%). Although this rise is small, it represents a relative 20% increase in PD catheter placement, suggesting that physician-facility relationships might impact treatment even if PD utilization remains low.

Nephrologists affiliated with for-profit facilities had a higher incidence of PD catheter placement than nephrologists affiliated with non-profit facilities or had no affiliation.

Rates of PD catheter placement were higher among nephrologist-affiliated facilities that offered PD compared with facilities only offering hemodialysis (HD) or nonaffiliated nephrologists.

Clinical Implications

This study found that treating ESKD with PD was more common when nephrologists were affiliated with for-profit dialysis facilities, facilities that offered PD, or both.

According to the authors, “[O]ur findings are consistent with the broader notion that stronger physician-facility alignment, whether via ownership or other forms of affiliations, may foster an environment supportive of home-based therapies.”

Additionally, financial and organizational incentives might improve PD utilization. Such incentives could motivate nephrologists and facilities to increase staffing, improve patient education, and support specialized PD training.

Reference

Alinezhad F, Young GJ, Hirth R, Cao J, Post B. Nephrologist affiliation with dialysis facilities and patient trajectories in end-stage kidney disease. JAMA Netw Open. 2026;9(4):e266156. doi:10.1001/jamanetworkopen.2026.6156