Hemoglobin Trends Change in Wake of Bundling

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NATIONAL HARBOR, Md.—Researchers have found that hemoglobin levels in dialysis patients have changed since implementation of the bundled payment system for dialysis services in January 2011, according to a report presented at the National Kidney Foundation 2012 Spring Clinical Meetings.

Researchers who analyzed data from 6,269 HD patients who received care in hospital-based dialysis clinics found that the proportion of patients with an Hb level above 12 dropped from 30.4% in January 2010 to 14.4% in December 2011 while the proportion of those with an Hb level below 10 rose from 11.9% to 19.6% during the same period. The mean Hb level decreased from 11.4 to 10.8.

The rapid increase in the proportion of patients with lower Hb is a concern because an Hb level below 10 is associated with a higher risk for transfusion, Anjali Acharya, MD, of the NYC Health and Hospitals Corp., New York, and colleagues noted in a poster presentation.

In a separate study presented at the meeting, a team led by Jay Wish, MD, of Cleveland Case Medical Center, looked at trends in anemia management among dialysis patients and found that average epoetin use decreased from the first quarter of 2010 to the second quarter of 2011 and average Hb levels decreased by 0.3 g/dL.

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