SAN DIEGO—Epoetin use and hemoglobin (Hb) levels have declined similarly for black and non-black dialysis patients following the advent of Medicare’s system of “bundled” payments for dialysis services and changes in dosing guidelines for erythropoiesis-stimulating agents (ESAs), according to data presented at the Kidney Week 2012.

The system of bundled payments debuted in January 2011 and ESA label changes for dosing occurred in June 2011.

From August 2010 to December 2011, mean Hb levels declined significantly from 11.5 to 11.1 g/dL, and the mean epoetin dose decreased significantly from 20,872 to 15,578 U/week. During that period, the percentage of patients with Hb levels below 9.0 and 9.0-9.9 g/dL increased significantly from 3.0% to 5.2% and from 5.7% to 10.5%, respectively, according to investigators led by Marc Turenee, PhD, of the Arbor Research Collaborative for Health in Ann Arbor.

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Declines in mean epoetin dose and Hb level accelerated following changes in ESA dosing guidelines, as did the proportion of patients with Hb levels below 10 g/dL, according to the investigators. The rates of change in epoetin dosing and Hb levels did not differ between blacks and non-blacks. The mean epoetin dose remained higher in blacks.

Additionally, the study revealed that the proportion of patients with an Hb level below 9 g/dL was significantly higher for blacks than non-blacks (4.7% vs. 3.4%). The two groups had similar proportions of patients with Hb levels of 9.0-9.9 (9.7% vs. 9.2%).

The racial differences in the prevalence of low Hb “indicate a need to examine possible racial disparities in blood transfusions and other anemia-related clinical outcomes,” the authors concluded.