Dialysis Care in the Post-Bundling Era

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Jody A. Charnow
Jody A. Charnow

For the ninth straight year, I came away from Kidney Week (formerly Renal Week), the annual scientific meeting of the American Society of Nephrology, feeling badly that Renal & Urology News can only report on a fraction of the thousands of studies presented at the meeting.

This year, as part of our on-site news coverage of Kidney Week for our website, we prepared reports on 36 of the approximately 4,000 studies presented. Kidney Week ended toward the end of the production cycle for this issue, but we had enough time to include on our front page a report on three studies presented at the conference suggesting that the care of dialysis patients has changed following implementation of the bundled payment system for dialysis services by the Centers for Medicare & Medicaid Services (CMS). Under this system, dialysis centers are paid a flat fee to cover all dialysis services and drugs.

In one study, a team led by Katie E. Cardone, PharmD, of the Albany College of Pharmacy and Health Sciences found that the use of ESAs has declined and the use of IV iron has increased since the debut of bundling on Jan. 1, 2011.

A number of factors might explain these trends, such as FDA changes in prescribing information reducing the recommended hemoglobin level at which epoetin dose is decreased or withheld. In another study, investigators showed that the prevalence of uncontrolled secondary hyperparathyroidism increased sharply among black dialysis patients after the debut of bundling. The researchers suggested that financial constraints resulting from bundling might may be a factor in the use of vitamin D analogues.

The January issue will carry full coverage of Kidney Week 2011, which includes a report on a study linking high salt intake with a lower risk of chronic kidney disease. Also, you may want to visit our website to hear Kidney Week podcasts of researchers talking about their studies and attendees responding to a survey question that asked: Do you think many CKD patients are being placed on dialysis too soon?

As 2011 draws to a close, the staff and editorial advisory board of Renal & Urology News would like to thank you for your continued readership. As always, feel free to e-mail me with any suggestions or comments. We hope you have a great holiday season.

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