TY - JOUR
T1 - Trends in Patient Characteristics and First-Year Medical Costs of Older Incident Hemodialysis Patients, 1995-2005
AU - Mau, Lih Wen
AU - Liu, Jiannong
AU - Qiu, Yang
AU - Guo, Haifeng
AU - Ishani, Areef
AU - Arneson, Thomas J.
AU - Gilbertson, David T.
AU - Dunning, Stephan C.
AU - Collins, Allan J.
PY - 2010/3/1
Y1 - 2010/3/1
N2 - Background: Characteristics of patients with chronic kidney disease who survive to end-stage renal disease may change over time, affecting subsequent outcomes and costs. We examined trends in older incident hemodialysis patient characteristics and analyzed first-year post-dialysis therapy initiation medical costs. Study Design: Retrospective cohort study. Setting & Participants: All US incident hemodialysis patients aged ≥67 years at dialysis therapy initiation from January 1, 1995, to December 31, 2005, with Medicare Part A and Part B in the prior 2 years. Predictor: Year of dialysis therapy initiation. Outcomes: Changes in patient characteristics and first-year costs. Measurements: Mean and median values for continuous variables and percentages of categorical variables; first-year total medical costs measured per person per year. Observed costs were adjusted using Medicare Price Indices and patient case-mix. Results: Median age at dialysis therapy initiation increased from 74.9 to 77.0 years from 1995 (n = 19,044) to 2005 (n = 31,796; P < 0.001). Diabetes prevalence increased from 54.2% to 64.1% (P < 0.001). Median estimated glomerular filtration rate increased from 8.0 to 11.2 mL/min/1.73 m2, and median hemoglobin level increased from 9.4 to 10.2 g/dL. Obesity increased from 8.9% to 22.9% (P < 0.001). First-year observed costs increased by 37.9%; however, inflation-adjusted and case-mix-inflation-adjusted costs were stable. Important adjusters for costs are inability to ambulate/transfer, baseline serum albumin level, primary end-stage renal disease cause, comorbid peripheral vascular disease, and baseline hospital days. Limitations: Population aged ≥67 years at dialysis therapy initiation and results may not generalize to the overall hemodialysis population. Conclusions: From 1995 to 2005, incident hemodialysis patients aged ≥67 years became older, sicker, and more obese with significantly increased estimated glomerular filtration rates and hemoglobin levels at dialysis therapy initiation. Increased first-year post-dialysis therapy initiation costs became stable over time after adjustment for price inflation; case-mix-inflation-adjusted costs remained constant, possibly because of mixed changes in patient characteristics.
AB - Background: Characteristics of patients with chronic kidney disease who survive to end-stage renal disease may change over time, affecting subsequent outcomes and costs. We examined trends in older incident hemodialysis patient characteristics and analyzed first-year post-dialysis therapy initiation medical costs. Study Design: Retrospective cohort study. Setting & Participants: All US incident hemodialysis patients aged ≥67 years at dialysis therapy initiation from January 1, 1995, to December 31, 2005, with Medicare Part A and Part B in the prior 2 years. Predictor: Year of dialysis therapy initiation. Outcomes: Changes in patient characteristics and first-year costs. Measurements: Mean and median values for continuous variables and percentages of categorical variables; first-year total medical costs measured per person per year. Observed costs were adjusted using Medicare Price Indices and patient case-mix. Results: Median age at dialysis therapy initiation increased from 74.9 to 77.0 years from 1995 (n = 19,044) to 2005 (n = 31,796; P < 0.001). Diabetes prevalence increased from 54.2% to 64.1% (P < 0.001). Median estimated glomerular filtration rate increased from 8.0 to 11.2 mL/min/1.73 m2, and median hemoglobin level increased from 9.4 to 10.2 g/dL. Obesity increased from 8.9% to 22.9% (P < 0.001). First-year observed costs increased by 37.9%; however, inflation-adjusted and case-mix-inflation-adjusted costs were stable. Important adjusters for costs are inability to ambulate/transfer, baseline serum albumin level, primary end-stage renal disease cause, comorbid peripheral vascular disease, and baseline hospital days. Limitations: Population aged ≥67 years at dialysis therapy initiation and results may not generalize to the overall hemodialysis population. Conclusions: From 1995 to 2005, incident hemodialysis patients aged ≥67 years became older, sicker, and more obese with significantly increased estimated glomerular filtration rates and hemoglobin levels at dialysis therapy initiation. Increased first-year post-dialysis therapy initiation costs became stable over time after adjustment for price inflation; case-mix-inflation-adjusted costs remained constant, possibly because of mixed changes in patient characteristics.
KW - Hemodialysis
KW - Medicare costs
KW - patient characteristics
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U2 - 10.1053/j.ajkd.2009.11.014
DO - 10.1053/j.ajkd.2009.11.014
M3 - Article
C2 - 20116913
AN - SCOPUS:77049093183
VL - 55
SP - 549
EP - 557
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 3
ER -