ORLANDO, Fla.—Red blood cell (RBC) transfusion rates have increased since the introduction of the Medicare prospective payment system (“bundling”) for end-stage renal disease (ESRD) care and changes to drug labeling for erythropoiesis stimulating agents (ESAs), researchers reported at the National Kidney Foundation’s 2013 Spring Clinical Meetings.

Under the prospective payment system, which took effect in January 2011, dialysis centers are reimbursed a flat fee to cover dialysis and previously separately billable medications and services. In June 2011, the FDA changed ESA labeling to recommend more conservative ESA dosing in patients with chronic kidney disease.

In a study of 42,790 chronic dialysis patients, investigators Zhun Cao, PhD, of Truven Health Analytics in Ann Arbor, Mich., and colleagues observed an overall upward trend in transfusion rates from January 2007 through March 2012. Since January 2011, the percentage of patients who received an RBC transfusion and the transfusion event rate increased more among Medicare patients than those with private insurance.

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Previous studies have shown that, since the introduction of bundling and changes to ESA labeling, epoetin alfa use and mean hemoglobin (Hb) levels have decreased and the proportion of patients with Hb levels below 10 g/dL have increased. The authors of the current study noted that decreases in ESA use and Hb levels may increase the potential need for RBC transfusions in ESRD patients and, as these transfusions are excluded from bundling, there is a potential for increased use of transfusions to supplement ESA treatment.

Analyses of data from the U.S. Renal Data System, which includes information on prevalent dialysis patients covered by Medicare, show that the proportion with a transfusion increased from 2.4% in September 2010 to 3.0% in September 2011 (a 24% increase), the researchers pointed out.