AUSTIN, Texas — A review of data up through 2016 now shows that the steady drop in the mortality rate among Medicare patients on dialysis that started more than a decade ago has abruptly ended and has gone up slightly, according to a poster presented here at the National Kidney Foundation Spring Clinical Meetings.
The dialysis community saw a steady drop in death rates among Medicare dialysis patients from 2001 to 2014, according to the U.S. Renal Data System, resulting in a fall from 230 to 168 deaths per 100 patient-years. However, lead author Eric Weinhandl, PhD, and colleagues Debabrata Ray, MS, and Allan Collins, MD, said the same database shows a slight increase in the mortality rate took place in 2015 — leveling off completely in 2016.
The authors offered several explanations as to the change in mortality status, such as consistently elevated distribution of blood pressure; less usage of renin-angiotensin system inhibitors; and reliance on the thrice-weekly schedule, with no change in the duration of the session.
In an interview with Healio Nephrology about the poster, Weinhandl said there were several possible explanations as to why fewer patient deaths were seen from 2000 to 2014, including:
- an increase in the use of fistulas and decrease in the use of catheters for vascular access; however, infection-related hospitalizations did not decrease concurrently;
- an increased use of cardioprotective medications;
- changes in erythropoiesis-stimulating utilization; and
- effects unrelated to dialysis in the broader economic, natural and social environments.
“Another possibility is a collateral effect of the Medicare Hospital Readmission Reduction Program, which may harm patients with heart failure,” the authors wrote. “Clinical innovation is urgently needed to improve survival. Better volume and cardiovascular disease management is likely key.” – by Mark E. Neumann
Weinhandl E, et al. Poster 163. Presented at: National Kidney Foundation Spring Clinical Meetings; April 10-14, 2018; Austin, Texas.
Disclosures: The authors report no relevant financial disclosures.