Many New ESRD Patients Haven’t Seen Nephrologist

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WASHINGTON—In 2007, many patients starting end-stage renal disease therapy received no nephrologist care, dietary counseling or therapy with erythropoietin-stimulating agents prior to treatment, suggesting that the transition to ESRD is poor in the United States, according to a new report from the U.S. Renal Data System.

The USRDS, funded by the National Institute of Diabetes and Digestive and Kidney Diseases, collects, analyzes, and distributes ESRD information in the United States.

One in three patients who started ESRD therapy in 2007 had seen a nephrologist for a year or less, according to the 2009 USRDS Annual Data Report, which was released Sept. 22. Twenty-four percent of 2007’s new ESRD patients had seen a nephrologist for a longer period of time, and 43 percent had not seen one at all. Furthermore, 90 percent of new patients did not receive any dietary counseling, and 71 percent didn’t receive erythropoietin-stimulating agent therapy.

“These findings suggest that planning for the transition to ESRD is poor, and that the Medicare CKD education benefit, included in the 2008 Medicare Improvement for Patients and Providers Act (MIPPA), needs to address the selection of patient modality and dialysis access, preemptive kidney transplantation and cardiovascular risk factors.”

ESRD Population

The ESRD population hit a new high in 2007 with 527,283 patients—368,544 were on dialysis and 158,739 were transplant patients, according to the USRDS report. That year, 87,812 ESRD patients died.

The number of new cases, however, remained the same between 2006 and 2007 at approximately 111,000. “These data suggest that the prevalent population is living longer, influencing both the growth of the treated ESRD population and the annual expenditures these patients incur,” according to the report.

The total number of transplants in 2007 was 17,513—6,041 from living donors—and the median time on the waitlist was 678 days, nearly twice as long as in 1995, according to the USRDS report. That number of transplants was a slight decrease from 18,052 transplants performed in 2006.

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