EXTON, Pa.—Nephrologists have reported changes in the use of erythropoietin stimulating agents (ESAs) and intravenous (IV) iron in the management of renal anemia in dialysis patients due to the new dialysis bundled payment system, according to a new report from BioTrends Research.
“ChartTrends: Renal Anemia in Dialysis” is a syndicated annual report series, in which over 200 nephrologists provide patient chart data on 1,000 dialysis patients in the United States to uncover the actual management of renal anemia.
Through an in-depth review of patient charts, details such as product dosing and titration, switching, concomitant medications, and a host of laboratory and patient demographic variables help define patient types and identify therapy triggers, according to BioTrends.
Based on patient-level audit data collected in March 2011, a number of key changes in the management of renal anemia in the dialysis setting have occurred compared to the prior year all resulting in reduced utilization of ESAs. Not only has overall treatment prevalence for ESAs declined in a year over year comparison to 2010, but hemoglobin levels are significantly lower at ESA initiation, at ESA hold, and overall levels, confirming reported intentions of targeting to a lower hemoglobin level.
Furthermore, a significant rise in subcutaneous injection was observed, according to the report. The study also noted a lower average ESA dose compared to the prior year and a rise in IV iron maintenance dose. There were some differences noted based on where patients receive dialysis (e.g., large dialysis organizations, small and medium chains, and independent units).
“This study confirms what the nephrology community had anticipated with regard to the treatment of renal anemia under the new payment system that was implemented in January,” according to Jay Wish, MD, Medical Director of the Dialysis Program at University Hospitals Case Medical Center in Cleveland. “Since anemia management is a big-ticket item for dialysis providers, it is likely that further cost-cutting will occur in this area and patient outcomes may become a concern.”
There are also a number of important differences in the management of renal anemia seen in the chart data between peritoneal dialysis and hemodialysis patients, according to the report. These differences could be very important – particularly if the advent of bundling leads to an increase in the percent of patients receiving peritoneal dialysis.
