WASHINGTON—In its first post-bundle analysis, the Dialysis Outcomes and Practice Patterns Study (DOPPS) found that the average hemoglobin levels in dialysis patients fell slightly between August 2010 and April 2011.
The numbers come from the DOPPS Practice Monitor (DPM), which provides up-to-date trends in clinical care as the new Prospective Payment System (PPS) for renal dialysis services, which were implemented in January.
The DPM reports represent data in the form of more than 800 regularly updated charts, figures, and data tables. The DPM provides comparisons and trends over time for the United States as a whole, using weighting techniques, and among patient groups and facility types.
The most recent DMP data summarized preliminary trends for hemodialysis patients overall, and for black versus non-black patients, between August 2010 and April 2011 (from before to soon after PPS implementation).
The DPM reported that, from August 2010 to April 2011, average hemoglobin levels fell slightly (0.10 g/dL). The percentage of patients with hemoglobin >12 g/dL declined from 31.4 percent to 28 percent. The percentage with hemoglobin <10 g/dL rose from 8.5 percent to 10 percent, and the percentage with hemoglobin <9 g/dL was stable at approximately 2.7 percent.
The average prescribed epoetin dose fell by approximately 3 percent and the average administered dose fell between 6 percent and 7 percent, with a notable drop in the higher epoetin dose range, according to DOPPS. The percentage of patients prescribed injectable iron per month rose from 57 percent to 78 percent.
Historically, higher epoetin doses have been given to black hemodialysis patients to achieve hemoglobin levels similar to those in non-black patients. Therefore, the new PPS may be expected to affect hemoglobin levels to a greater extent in black patients, according to DOPPS. Over this reporting period, average hemoglobin levels fell more in blacks than non-blacks (0.23 g/dL versus 0.04 g/dL). The percentage of patients with hemoglobin >12 g/dL fell more in blacks (from 34.7 percent to 26.9 percent) than in non-blacks (from 31 percent to 28.5 percent). The percentage of patients with hemoglobin <10 g/dL rose in blacks (from 8.7 percent to 11.1 percent), with little to no change in non-blacks.
Mineral and Bone Disorder Management
Overall, the average PTH level rose sharply from 337 to 435 pg/mL from August 2010 to April 2011, an increase of 29 percent, according to the DOPPS analysis. No substantial changes were seen in serum phosphorus or calcium values (two other markers of mineral and bone disorder). The reasons for the rise in PTH are being investigated; large changes in use of injectable vitamin D or oral medications are not yet apparent.
Black dialysis patients tend to have higher PTH levels and receive higher intravenous vitamin D doses than non-black patients. Over this reporting period, average PTH values rose 29 percent in black patients and 26 percent in non-black patients. Very high PTH values (defined here as PTH >600 pg/mL) rose from 17 percent to 27 percent in black patients versus 9 percent to 14 percent in non-black patients.
The DOPPS collects data from representative samples of dialysis facilities in 11 other countries. Early data indicate that the above changes in U.S. dialysis care were not seen in Europe and Japan over the same time, according to DOPPS. This suggests that the observed changes in the U.S. data may reflect responses to Medicare’s new payment system, rather than trends in care for other reasons.
The next update of the DPM website, in December, will provide data through August.