YOU ARE HERE:   Home > Contact Us > Media/Press information > DOPPS Practice Monitor: Update on Trends in US Hemodialysis Care Following Launch of Bundled Payment System and Revisions to ESA Labels

Emerging trends in hemodialysis care through August 2011, based on a sample of US dialysis facilities, are included in the latest update to the DOPPS Practice Monitor (DPM, at http://www.dopps.org/DPM), run by the Dialysis Outcomes and Practice Patterns Study (DOPPS) at Arbor Research Collaborative for Health.

• Anemia:Hemoglobin levels have decreased since the June 2011 ESA label update. While the mean hemoglobin level declined by 0.12 g/dL over 12 months from August 2010 to July 2011, it declined in August 2011 by another 0.10 g/dL to 11.26 g/dL. The percentage of patients with hemoglobin levels greater than 12 g/dL declined sharply (from 28% to 23%) in July/August 2011, while the percentage with hemoglobin levels less than 10 g/dL increased slightly from 8.5% to 10% and the percentage with hemoglobin levels less than 9 g/dL remained under 3%.
  
  Mean prescribed epoetin dose (among patients receiving epoetin) decreased by 15%, from 21,100 units/wk to 17,900 units/wk, from August 2010 to August 2011, with the greatest decline in June-August 2011. Epoetin doses at the higher end of the dose range have decreased most notably. IV iron use increased from August 2010 to August 2011 though has recently stabilized. In keeping with greater IV iron use, serum ferritin levels (indicative of iron stores) continue to rise. Serum ferritin concentration exceeded 500 ng/mL in 65% of patients, 800 ng/mL in 34% of patients, and 1,200 ng/mL in 11% of patients in August 2011.
  
  
• Mineral & Bone Disorder: In our last report, we noted a 29% increase in serum parathyroid hormone (PTH) levels through April 2011, and differences by race were described. Since then, PTH levels have remained stable or declined slightly in both black and non-black patients. In August 2011, 22% of black patients and 12% of non-black patients had very high PTH values (defined here as PTH >600 pg/mL). The percentage of hemodialysis patients for whom PTH is measured has declined slightly since August 2010. There have been no clear changes in serum calcium or serum phosphorus levels.
  
  
• Clinical Outcomes: Preliminary data indicate that the 30-day hospitalization rate has increased somewhat from August 2010 to August 2011. The DPM does not report yet on trends in red blood cell transfusions, as dialysis units are often unaware of transfusions occurring in the inpatient setting. Additional efforts to comprehensively monitor trends in transfusions are warranted. To date mortality rate has not changed appreciably, though further follow-up time is necessary as we continue to track this outcome.
  

Future monitoring of these trends, confirmation with national data when eventually available, and understanding their effect on clinical outcomes, if any, is required.

About the DPM: The DPM reports representative data in the form of more than 800 regularly updated charts, figures, and data tables. The DPM is based on a sample of over 4,000 patients in ~140 US dialysis units. It provides comparisons and trends over time (representative of the United States as a whole), using weighting techniques. Data are also provided by race and facility types. Research papers describing the DPM methods [Robinson et al. 2011]¹ and an overview of key findings through April 2011 [Robinson et al. 2012 in press]² have been published. DPM data are aggregated across dialysis organizations and facilities. Aggregated trends may not reflect trends in individual dialysis organizations or facilities, and are not intended to provide oversight of performance in individual dialysis organizations or facilities.

About the DOPPS: The DOPPS is a prospective cohort study investigating practices related to the best outcomes for hemodialysis patients in 12 countries. Administered by the nonprofit Arbor Research Collaborative for Health of Ann Arbor, Mich., the DOPPS is supported by scientific research grants from Amgen (since 1996), Kyowa Hakko Kirin (since 1999, in Japan), Abbott (since 2009), Sanofi/Genzyme (since 2009), Baxter (since 2011), and Vifor Fresenius Medical Care Renal Pharma Ltd (since 2011) without restrictions on publications. Arbor Research has a broad base of funding that includes support from four divisions of the US Department of Health and Human Services, as well as from industry sources.

Dialysis Care in the US: More than 380,000 people receive long-term dialysis for the treatment of end-stage kidney failure in the United States. In 2008, Medicare expenditures for dialysis patients approached $21 billion, or 4.6% of the total Medicare budget. The Centers for Medicare & Medicaid Services (CMS) launched the new Prospective Payment System (PPS), in January 2011, to be compliant with the statutory requirement of the Medicare Improvements for Patients and Providers Act (MIPPA), enacted July 15, 2008, to control dialysis costs through bundled payments. In a 2010 report, the US Government Accountability Office (GAO) stated that access to and quality of dialysis care should be measured promptly as the PPS is implemented.

¹Robinson B, Fuller D, Zinsser D, Albert J, Gillespie B, Tentori F, Turenne M, Port F, Pisoni R. The Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor: rationale and methods for an initiative to monitor the new US bundled dialysis payment system. Am J Kidney Dis (2011) 57: 822-831
²Robinson BM, Fuller DS, Bieber BA, Turenne MN, Pisoni RL. The DOPPS Practice Monitor for US Dialysis Care: Trends Through April 2011. Am J Kidney Dis (2012); In press. epublished 12/12/11. DOI: 10.1053/j.ajkd.2011.11.005

Inquiries to:
Katherine Pearson
Communications Coordinator
Arbor Research Collaborative for Health
(734) 369-9639
communications@ArborResearch.org