Two studies presented at the recent National Kidney Foundation (NKF) 2013 Spring Clinical Meetings provide more evidence of a trend toward decreasing use of erythropoiesis-stimulating agents (ESAs) and decreasing hemoglobin levels following the introduction in January 2011 of the Medicare prospective payment system (“bundling”) for dialysis-related care and changes in ESA drug labeling that occurred in June 2011.
Both studies also identified a trend toward higher blood transfusion rates, and the authors of one study cited data from the U.S. Renal Data System showing that the proportion of dialysis patients with a transfusion increased from 2.4% in September 2010 to 3.0% in September 2011, a 24% increase.
Although the reasons for this increase require further study, the authors noted in a poster presentation that, because transfusions are excluded from bundling, there is a potential for increased use of transfusions to supplement ESA use. At this point, it is likely unclear how much this affects or will affect the federal government’s cost of dialysis-patient care, but it would not surprise me if the Centers for Medicare and Medicaid Services are monitoring the trend closely.
Also at the NKF conference, physician thought-leaders took part in debates on various controversial clinical topics. We invited the same doctors to summarize their views for Renal & Urology News in video podcasts that we packaged as two Point & Counterpoint debates. One debate centers on anticoagulant use for atrial fibrillation in chronic kidney disease/end-stage renal disease and the other addresses population-based screening for kidney disease.
This issue also has articles reporting on study findings from the European Association of Urology (EAU) 28th Annual Congress in Milan. Our coverage includes a report on an investigation showing that radical prostatectomy can be an appropriate treatment for patients with high-risk prostate cancer (PSA above 20 ng/mL and/or a Gleason score of 8 or higher, and/or T2c or greater disease). Men with one, two, or three of these risk factors had a five-year metastasis-free survival rate of 91.1%, 84.9%), and 71.7%, respectively.
Our EAU coverage also includes a report on two U.S. studies of kidney stones, one showing an increase in emergency department visits for kidney stones, particularly among women, and the other demonstrating an increase in the use of percutaneous nephrolithotomy.
From May 18-22, visit our website for our on-site coverage of the American Transplant Congress in Seattle. While visiting the website, check out our extensive coverage of the American Urological Association annual meeting in San Diego (May 4-8).
As always, feel free to contact me with any comments or suggestions related to editorial content.