Trends in chronic peritoneal dialysis utilization in New England.

Utilization of chronic peritoneal dialysis (CPD) continues to decline in the United States. Technique failure remains a key factor in this decline. Center size has been associated with technique failure. Afolalu et al. observed that technique failure rates were higher in units with fewer than 25 patients. We wondered if declining CPD utilization rates are reflective of changes in small or large units. Using the 2000 overall census of individual CPD units in Network #1, New England, between January 1, 2000, and December 31, 2008, we divided the units by size: units with fewer than 25 patients, and units with 25 patients or more. The CPD patient population increased to 1264 patients in 2008 from 1238 patients in 2000 (a 2% increase). A total of 85 units provided CPD therapy in 2000, increasing to 95 units in 2008. Of the 85 units in 2000, 11 managed 25 patients or more. By 2008, 8 of those 11 units had experienced a drop in CPD census. In 2000, larger units had been caring for 547 patients in total; in 2008, larger units were caring for a total of 546 patients. In 2000, 74 units had fewer than 25 patients, and smaller units were caring for a total of 691 patients. By 2008, smaller units were caring for 718 patients in total. Our finding that larger units with 25 patients or more experienced an average decline of 34% in CPD census is a major concern. Growth in the total number of smaller units was not associated with overall CPD growth. Further studies are needed to describe the reasons for decline in CPD census noted in most of the larger units.