Home Dialysis in the New USA Bundled Payment Plan: Implications and Impact

Golper, Thomas A.; Guest, Steven; Glickman, Joel D.; Turk, J.; Pulliam, Joseph

doi:10.3747/pdi.2010.00143

Cited by 32 publications

(30 citation statements)

References 10 publications

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“…Until additional research can be performed to elucidate the underlying mechanisms of this mortality risk, dialysis units should focus on providing optimum support to rural patients, ensuring delivery of high-quality PD through nursing communication, home visits, and training reinforcement. This is especially relevant given recent changes in Medicare reimbursement due to bundling, which are expected to increase PD use nationally as a result of projected cost savings (25).…”

Section: Discussionmentioning

confidence: 99%

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Maripuri

Arbogast

İkizler

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Micropolitan and rural patients face challenges when initiating dialysis, including healthcare access. Previous studies have shown little association of nonurban residence with dialysis outcomes but have not examined the association of dialysis modality with residence location.Design, setting, participants, & measurements This retrospective cohort study used data from the U.S. Renal Data System. Adults who initiated maintenance dialysis between January 1, 2006, and December 31, 2007, were classified as rural, micropolitan, or urban. Early and long-term mortality and kidney transplantation were examined with Cox regression stratified by dialysis modality.Results Of 204,463 patients, 80% were urban; 10.2%, micropolitan; and 9.8%, rural. Micropolitan and rural patients were older, were less racially diverse, had more comorbid conditions, and were more likely to start peritoneal dialysis (PD). Median follow-up was 2.0 years. Early mortality or long-term hemodialysis (HD) mortality did not significantly differ by geographic residence. After adjustment, micropolitan and rural PD patients had higher risk for long-term mortality (hazard ratio [HR] Conclusions Micropolitan and rural residence is associated with higher mortality in PD patients and similar or higher likelihood of kidney transplantation among HD and PD patients. Studies examining the underlying mechanisms of these associations are warranted.

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Section: Discussionmentioning

confidence: 99%

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Maripuri

Arbogast

İkizler

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…5,25 Although Medicare endorses a reimbursement policy as a means to promote PD therapy growth, 26 we raise caution that profitability might encourage implementation of urgent-start PD without sufficient planning and assessment needed to safeguard patient outcomes. The basis for urgent-start PD should always be patient centered and not enterprise driven.…”

Section: Nephrologistmentioning

confidence: 99%

Urgent-Start Peritoneal Dialysis: A Chance for a New Beginning

Arramreddy

Zheng

Saxena

et al. 2014

American Journal of Kidney Diseases

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Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates. Recently, the term urgent-start PD has gained momentum across the nephrology community and has begun to change this status quo. It allows for expedited placement of a PD catheter and initiation of PD therapy within days. Several published case reports, abstracts, and poster presentations at national meetings have documented the initial success of urgent-start PD programs. From a wide experiential base, we discuss the multifaceted issues related to urgent-start PD implementation, methods to overcome barriers to therapy, and the potential impact of this technique to change the existing dialysis paradigm.

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“…Recent reimbursement changes in the US healthcare system may result in greater use of peritoneal dialysis [7]. Malnutrition and comorbidities (including cardiovascular disease, chronic respiratory or liver disease, and carcinoma) are independently associated with mortality in patients undergoing peritoneal dialysis, and these two factors in combination are associated with the worst outcomes [8].…”

Section: Introductionmentioning

confidence: 99%

Lanthanum carbonate versus placebo for management of hyperphosphatemia in patients undergoing peritoneal dialysis: a subgroup analysis of a phase 2 randomized controlled study of dialysis patients

et al. 2013

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BackgroundThis short-term study assessed the efficacy and safety of lanthanum carbonate in the treatment of hyperphosphatemia in dialysis patients; here, we report a prespecified subgroup analysis of patients undergoing peritoneal dialysis.MethodsMen and women (n = 39) who had received continuous ambulatory peritoneal dialysis for chronic kidney disease for 6 months or more were enrolled in eight renal medicine departments in the United Kingdom. A 2-week washout period was followed by a 4-week dose-titration phase during which patients received lanthanum carbonate titrated up to 2250 mg/day. This was followed by a 4-week, randomized, placebo-controlled, parallel-group phase during which patients continued to receive either lanthanum carbonate at the titrated dose, or a matched dose of placebo. The main outcome measure was control of serum phosphate levels (1.3-1.8 mmol/l) at the end of the parallel-group phase.ResultsSerum phosphate was controlled in 3/39 (8%) patients at the beginning of the dose-titration phase (after washout) and in 18/31 (58%) patients treated with lanthanum carbonate at its end. After the parallel-group phase, 60% of lanthanum carbonate-treated patients and 10% of those receiving placebo had controlled serum phosphate. There was no difference in mean (95% confidence interval) serum phosphate levels between groups at randomization: lanthanum carbonate, 1.57 (1.34-1.81) mmol/l; placebo, 1.58 (1.40-1.76) mmol/l (p = 0.96). However, a difference was seen at the end of the parallel-group phase: lanthanum carbonate, 1.56 (1.33-1.79) mmol/l; placebo, 2.25 (1.81-2.68) mmol/l (p = 0.0015). There were no clinically important changes in nutritional parameters and no serious treatment-related adverse events were recorded.ConclusionsAt doses up to 2250 mg/day, lanthanum carbonate is well tolerated and controls hyperphosphatemia effectively. Treatment with higher doses of lanthanum carbonate may allow patients undergoing peritoneal dialysis the potential to increase their dietary protein intake without compromising their phosphate control.

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Home Dialysis in the New USA Bundled Payment Plan: Implications and Impact

Cited by 32 publications

References 10 publications

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Urgent-Start Peritoneal Dialysis: A Chance for a New Beginning

Lanthanum carbonate versus placebo for management of hyperphosphatemia in patients undergoing peritoneal dialysis: a subgroup analysis of a phase 2 randomized controlled study of dialysis patients

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