Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Did This Impact Transfusion Rate in Hemodialysis?
JAMA Intern Med; 2016 Dec 24; Wang, Kane, et al
Risks of major adverse CV events and death for older fee-for-service Medicare patients undergoing hemodialysis did not differ after bundling policy and erythropoiesis-stimulating agents (ESAs) labeling policy changes, according to a retrospective cohort study involving nearly 70,000 individuals. Stroke risk was reduced, and blood transfusion rate increased slightly.
Participants were divided into 2 groups based on initiating dialysis before or after the policy changes. Investigators looked how the changes impacted CV events. Among the results:
- Risk of major CV events, death, congestive heart failure, and venous thromboembolism were similar in both periods.
- Those who initiated dialysis after the policy changes saw their odds of stroke decreased by 23%.
- ESA use also decreased.
- Rate of blood transfusions increased by nearly 10%.
- Black patients who initiated dialysis after the policy changes saw their odds of major CV events and all-cause mortality each decreased by 18%.
Wang C, Kane R, Levenson M, et al. Association between changes in CMS reimbursement policy and drug labels for erythrocyte-stimulating agents with outcomes for older patients undergoing hemodialysis covered by fee-for-service Medicare. JAMA Intern Med. 2016;176(12):1818-1825. doi:10.1001/jamainternmed.2016.6520.