Uncontrolled SHPT On the Rise in Blacks Since Debut of 'Bundling'

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PHILADELPHIA—Uncontrolled secondary hyperparathyroidism (SHPT) has been on the increase among black hemodialysis (HD) patients since the recent implementation of the federal government's prospective payment system for dialysis services, researchers reported at Kidney Week 2011.

Under this system, dialysis centers receive a flat amount for care provided to dialysis patients, a payment system commonly referred to as “bundling.” Francesca Tentori, MD, of the Ann Arbor Research Collaborative for Health in Ann Arbor, Mich., and colleagues explained that increased financial constraints resulting from bundling may lead to reduced use of intravenous (IV) vitamin D analogs and thus poorer control of SHPT. Black patients on average require higher doses of these analogues, so they may be particularly susceptible to this change, they stated.

Using data from the DOPPS Practice Monitor, which follows a nationally representative sample of about 140 U.S. dialysis centers serving 20 or more chronic HD patients, researchers examined trends in parathyroid hormone (PTH) values and SHPT therapies from July 2010 to February 2011.

The median PTH value increased from 296 to 379 pg/mL among blacks and from 244 to 283 pg/mL among non-black. The prevalence of severe uncontrolled SHPT (defined as a PTH level above 600 pg/mL) increased sharply from 16% on July 2010 to 26% on February 2011, but only slightly from 9% to 11% among non-blacks.

The investigators stated that these changes do not appear to be related to decreased overall use of SHPT treatments—as the proportion of patients prescribed IV vitamin D increased slightly in both blacks and non-blacks—or to changes in serum calcium or phosphorus.

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