PHILADELPHIA—After the introduction of a bundled payment system for dialysis services in January 2011 and revised labeling for erythropoiesis-stimulating agents (ESAs) that same year, ESA use decreased and iron use increased among U.S. patients on dialysis, according to data presented at Kidney Week 2014.

David T. Gilbertson, PhD, of the Chronic Disease Research Group, Minneapolis, Minn., and colleagues analyzed 2005–2011 data from the Centers for Medicare and Medicaid Services end-stage renal disease database. The study included all individuals aged 18 years and older on hemodialysis (HD) or peritoneal dialysis (PD) for 9 months or more, with Medicare as the primary payer for at least 6 months. From 2005–2010, about 90% of HD patients used epoetin (EPO); this declined to 85% in 2011.

Among PD patients, EPO use remained constant at about 70%. From 2005–2011, the mean monthly EPO does in HD patients fell from about 69,000 to 43,000 units; for PD patients, the dose was more consistent but began to decline in 2010, reaching a low of 28,000 units in 2011 from a peak of 41,000 units in 2008.

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In HD and PD patients, quarterly iron use rose from 69% and 21%, respectively, in 2005 to 75% and 39% in 2011. In contrast, iron dose increased from 2005–2010 before declining in 2011 in both groups. In HD and PD patients, hemoglobin levels fell from 11.9 and 11.6 g/dL, respectively, in 2005 to 10.7 and 10.5 g/dL in 2011.