PHILADELPHIA—Epoetin alfa (EPO) use has decreased and intravenous (IV) iron use has increased significantly in private dialysis units since the introduction of the Medicare bundling rule for end-stage renal disease services, data presented at Kidney Week 2011 suggest.

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Investigators examined data from two private nonprofit dialysis centers for the period from January 2010 to April of 2010 (pre-bundling) and from January 2011 to April 2011 (post-bundling). They evaluated 1,470 patient-months.

Among in-center hemodialysis patients receiving EPO, mean monthly doses decreased from 62,758 before bundling to 44,140 units after bundling. For those on IV iron, mean monthly doses rose from 306 to 453 mg. Mean hemoglobin concentrations were significantly lower after implementation of bundling (11.1 vs. 11.6 g/dL before bundling), but remained within the target range. The study, by Katie E. Cardone, PharmD, of the Albany College of Pharmacy and Health Sciences in Albany, N.Y., and collaborators revealed similar trends in both home hemodialysis (HHD) and peritoneal dialysis (PD) patients. Both the HHD and PD groups had a 0.5 g/dL decrease in Hb levels in the post-bundle observation period.