Red blood cell (RBC) transfusion rates among US chronic dialysis patients during changes to Medicare end-stage renal disease (ESRD) reimbursement systems and erythropoiesis stimulating agent (ESA) labels

Cappell, Katherine; Shreay, Sanatan; Varker, Helen; Paoli, Carly J.; Gitlin, Matthew

doi:10.1186/1471-2369-15-116

Cited by 18 publications

(14 citation statements)

References 19 publications

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“…One key finding concerned the relationship between hemoglobin variability and use of red blood cell transfusions. While other studies have demonstrated increasing use of transfusions in recent years [ 34 , 35 , 36 ], the present report provides additional detail. Transfusions increased most strikingly in the LL group, suggesting that transfusions have become a more important treatment option in patients with persistently low hemoglobin levels.…”

Section: Discussionmentioning

confidence: 77%

Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

Gilbertson¹,

Hu²,

Peng³

et al. 2017

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Background: Given regulatory and reimbursement changes in anemia management, we examined hemoglobin variability in a contemporary cohort of maintenance hemodialysis patients. Materials and methods: The study population included > 200,000 hemodialysis patients with Medicare parts A and B as primary payer on October 1, 2012. Based on 25th and 75th percentiles, monthly hemoglobin values were categorized as low, intermediate, or high. Six variability categories were created by patterns during the 6-month observation period. Stable categories were: always-low, always-intermediate, always-high; variable patterns were: varying between low and intermediate, intermediate and high, low and high (most-variable). Cox proportional hazard models were used to assess the association between hemoglobin variability and all-cause mortality or major adverse cardiac events (MACE). Results: The 25th and 75th hemoglobin percentiles were 10.2 and 11.5 g/dL, respectively, in 2012, vs. 11 and 12.5 g/dL in 2004. ESA doses were lower in all categories in 2012 and transfusion rates higher, particularly for always-low patients. Hemoglobin variability decreased modestly: in 2004, 6.0% were always-intermediate, vs. 9.5% in 2012. In 2012, more patients were always-high and fewer were most-variable. Mortality hazard ratios (HRs) were higher for patients with any low hemoglobin: always-low (HR, 95% CI: 2.07, 1.84 – 2.31), varying between low and intermediate (1.37, 1.29 – 1.45), and most-variable (1.23, 1.16 – 1.31); the pattern was similar for MACE. Conclusions: In 2012 vs. 2004, hemoglobin levels decreased, the range of levels narrowed, and variability decreased modestly; transfusions increased. The highest risk of mortality and MACE appeared to occur in patients with persistently low, rather than highly variable, hemoglobin levels.

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Section: Discussionmentioning

confidence: 77%

Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

Gilbertson¹,

Hu²,

Peng³

et al. 2017

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“…This retrospective observational cohort study used (i) Truven Health MarketScan ® Commercial Claims and the Medicare Supplemental database and (ii) the Oncology Services Comprehensive Electronic Records (OSCER) database, which includes information on cancer patients from US outpatient community and hospital‐affiliated oncology practices . Both databases are fully compliant with the Health Portability and Accountability Act of 1996, and all data were deidentified to protect the privacy of patients and providers.…”

Section: Methodsmentioning

confidence: 99%

Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes

Gawade

Berlin

Henry

et al. 2017

Pharmacoepidemiology and Drug

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“…Our primary definition of chronic dialysis dependence was at least one occurrence of BETOS 9A or 9B during the 12 months before the index fistula/graft month or within 30 days after creation of the index fistula/graft (8). A sensitivity analysis defined dialysis dependence by occurrence of BE-TOS 9A or 9B in 3 consecutive months, with the third month being no later than 2 months after the index fistula/graft month (9).…”

Section: Methodsmentioning

confidence: 99%

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Woo¹,

Goldman

Romley

2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Recent evidence indicates that fistula maturation and patency may be compromised in the elderly dialysis population compared with younger patients. The objective of this study was to characterize the short-term outcomes of arteriovenous fistulas and arteriovenous grafts for hemodialysis access in the Medicare population.Design, setting, participants, & measurements This was a retrospective cohort study performed using Medicare Part A and B claims data from 2006 through 2011. The study population included 16,464 dialysis-dependent patients age $66 years undergoing arteriovenous fistula and arteriovenous graft creation. The primary outcome measure was incidence of repeat fistula/graft creation and tunneled catheter placements in the 12 months after arteriovenous fistula and graft creation.Results In the 12 months postindex fistula/graft, the mortality in the fistula group was 28.2% versus 29.9% in the graft group (P=0.03). A repeat fistula/graft creation was required in 26.9% of patients in the fistula group and 16.7% in the graft group (P,0.001). There was no significant difference in the proportion of patients who required a tunneled hemodialysis catheter in the 12 months after an index fistula creation (fistula 28.4% versus graft 27.3%, P=0.19). In the index fistula group, 44.4% of patients required a repeat fistula/graft creation and/or a tunneled catheter, compared with 33.7% in the graft group (P,0.001). At 365 days after the index fistula/graft, the repeat fistula/graft/catheter-free survival was 39.7% in the fistula group versus 46.0% in the graft group (P,0.001). Index fistula was associated with a higher risk of loss of repeat fistula/graft/catheter-free survival with an odds ratio of 1.19 (95% confidence interval, 1.13 to 1.24).Conclusions Fistulas were associated with a somewhat lower mortality than grafts in the first 12 months after creation. However, the incidence of repeat fistula/graft creation and tunneled catheter placement is substantially higher in the first 12 months after fistula creation compared with grafts. One-year repeat fistula/graft/catheterfree survival is lower after fistula creation than grafts.

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Red blood cell (RBC) transfusion rates among US chronic dialysis patients during changes to Medicare end-stage renal disease (ESRD) reimbursement systems and erythropoiesis stimulating agent (ESA) labels

Cited by 18 publications

References 19 publications

Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

Changes in the use of erythropoiesis‐stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

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