Nephrologist Affiliation With Dialysis Facilities and Patient Trajectories in End-Stage Kidney Disease

Are nephrologist affiliations with dialysis facilities and facility characteristics associated with peritoneal dialysis (PD) catheter placement and kidney transplant surgery in patients initiating dialysis?In this cohort study of 28 040 Medicare beneficiaries initiating dialysis between 2013 and 2022 and followed up to 24 months, patients whose nephrologists were affiliated with a dialysis facility had a higher adjusted cumulative incidence of PD catheter placement than those treated by a nonaffiliated nephrologist. Adjusted differences in kidney transplant surgery within 24 months were small and not statistically significant; a negative control outcome (joint replacement surgery) showed no meaningful association with affiliation.These findings suggest that although financial and institutional factors—including nephrologist affiliation with dialysis facilities—were associated with PD uptake, such affiliation did not limit early kidney transplant surgery.

Corresponding Author: Brady Post, PhD, Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, 316H Robinson Hall, 336 Huntington Ave, Boston, MA 02115 (b.post@northeastern.edu).

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