Chronic kidney disease (CKD) is a condition that requires access to renal replacement therapies (RRTs) to enable patients to live. The use of such therapies has been continuously researched due to the high cost to payers and their patients. This dissertation aimed to analyze the incidence, prevalence, and mortality of renal replacement therapies in patients with end-stage renal disease (ESRD), and document cost trends and analyze possible inequalities in access to these therapies. Based on an integrated health risk management (IHRM) model, this study examined patient characteristics associated with renal replacement therapies in ESRD patients through a pooled cross-sectional study based on USRDS (United States Renal Data System), and examined information related to costs and utilization of health services one year after the initiation of dialysis through a retrospective cohort study. Findings suggest that morbidity and mortality measures of renal replacement therapies continue to increase from 2001 to 2018, and costs continue to decrease from 2014 to 2017 in the United States. In-center hemodialysis (ICHD) (196.2 cases per 100,000 inhabitants) continues to be the most prevalent RRT utilized over home hemodialysis (HHD) (4.4 cases per 100,000 inhabitants) and peritoneal dialysis (PD) (24.7 cases per 100,000 inhabitants). The cost for ICHD (306,705,989 million dollars) is significantly higher than HHD (234,559,170 million dollars) and PD (5,360,136 million dollars). White patients have a 25% lower probability of accessing in-center hemodialysis compared to patients of other races. Hispanic patients were also found to be 31% more likely to access in-center hemodialysis compared to non-Hispanic patients, which would indicate potential inequities in access to these alternative RRTs. Study findings provide critical data to inform decision-makers on the use of HHD, PD, and ICHD among ESRD patients in the US and increase awareness of PD and HHD to reduce long-term costs to the healthcare system.


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Graduation Date





Hou, Su-I


Doctor of Philosophy (Ph.D.)


College of Community Innovation and Education


School of Public Administration

Degree Program

Public Affairs; Health Services Management & Research


CFE0009730; DP0027838





Release Date

August 2023

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)