Racial Disparities in Peritoneal Dialysis Utilization Among Patients With Hypertensive End-Stage Renal Disease: A Population-Level Analysis (2012-2022)

Objective: Hypertension is a leading cause of chronic kidney disease and end-stage renal disease (ESRD). Peritoneal dialysis (PD) offers advantages over hemodialysis, including improved hemodynamic stability and greater patient autonomy, yet remains underutilized. Emerging evidence suggests persistent racial/ethnic disparities in PD use. Design and method: We conducted a population-level analysis of adults aged 25 years or older with hypertension-associated ESRD receiving renal replacement therapy between 2012 and 2022 using a large national registry. PD utilization was calculated annually as the proportion of patients receiving PD among all hypertensive ESRD patients requiring renal replacement therapy. Longitudinal trends were evaluated across racial/ethnic groups. Pearson correlation coefficients assessed variation in temporal PD utilization trends between White patients versus Black and Hispanic patients, and Asian patients versus Black and Hispanic patients. Results: From 2012 to 2022, overall peritoneal dialysis (PD) utilization increased modestly across the population. PD utilization was consistently high among White and Asian patients, both reaching approximately 11.9% and 12.5% respectively by 2022. In contrast, Black and Hispanic patients demonstrated persistently lower PD utilization, increasing to approximately 6.9% and 7.8% by the end of the study period. Paired t-test analysis revealed that PD utilization rates for White patients differed significantly from both Black and Hispanic patients throughout the decade (p < 0.001). Similarly, utilization rates for Asian patients were significantly higher than those of Black and Hispanic patients (p < 0.001). While temporal increases followed parallel trajectories across all groups, substantial absolute disparities persisted without evidence of convergence.Conclusions: Although PD utilization increased modestly over the past decade, significant racial/ethnic disparities persist among patients with hypertension-related ESRD. Parallel adoption trends suggest enduring structural barriers rather than delayed uptake. Targeted policy and patient-level interventions are urgently needed to promote equitable access to peritoneal dialysis therapies.