ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2025
Neighborhood Built Environment and Home Dialysis Utilization: Varying Patterns by Urbanicity-Dependent Patterns and Implications for Policy.
Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Social Risk Factors and Peritoneal Dialysis Use Among Maintenance Dialysis Patients: A National Cross-Sectional Study.Kidney medicine · 2026Article
- Home Dialysis Utilization in Puerto Rico.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2026Article
- Trends, underlying-cause structure, and penetration of end-stage kidney disease involvement in U.S. mortality, 1999-2023: a multiple-cause-of-death analysis.Frontiers in public health · 2026Article
- Environmental and social injustices impact dementia risk among older adults with end-stage kidney disease: a national registry study.Lancet regional health. Americas · 2025Article
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Authors and funding
13 authors.
Funding
Abstract
RATIONALE &
objectiveDespite national efforts, the uptake of home dialysis (peritoneal dialysis or home hemodialysis) remains low. Characteristics of the built environment may differentially impact home dialysis use. STUDY
designRetrospective cohort study (2010-2019). SETTING &
participants1,103,695 adults (aged≥18 years) initiating dialysis in the US Renal Data System. EXPOSURE: We examined 3 built environment domains based on residential ZIP code: (1) medically underserved areas (MUAs), defined as neighborhoods with limited primary care access; (2) distance to the nearest dialysis facility; and (3) distribution of housing characteristics (structure and overcrowding). OUTCOME: Uptake of home dialysis modalities at dialysis initiation. ANALYTICAL APPROACH: We quantified associations between built environment characteristics and home dialysis initiation using multilevel logistic regression stratified by urbanicity type (urban, suburban, small-town, and rural).
resultsAmong adults initiating dialysis, 40.8% lived in MUAs. Across ZIP codes, the mean percentage of overcrowded housing was 4.2% (SD, 4.7%), and the percentage of detached housing was 61.1% (SD, 21.1%); mean distance to the nearest dialysis facility was 5.5km (SD, 9.1km). Living in MUAs was associated with reduced home dialysis use only in urban (OR, 0.94; 95% CI, 0.91-0.96) and suburban (OR, 0.92; 95% CI, 0.89-0.94) areas. Similarly, housing overcrowding was associated with decreased home dialysis use only in urban (OR, 0.88; 95% CI, 0.86-0.89) and suburban (OR, 0.91; 95% CI, 0.90-0.93) areas. Longer distance to a dialysis facility was the most salient neighborhood factor associated with increased home dialysis use in small towns (OR, 1.14; 95% CI, 1.12-1.16) and rural areas (OR, 1.17; 95% CI, 1.15-1.19). LIMITATIONS: Housing characteristics were measured at the ZIP code level.
conclusionsBuilt environment characteristics associated with home dialysis uptake vary by urbanicity. Policies should address built environment barriers that are specific to urbanicity level. For example, increasing the frequency of dialysate delivery schedules could address housing space constraints in urban and suburban areas, and promoting home dialysis might be more effective for patients living far from dialysis centers in small-town and rural areas.
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