The ESRD composite rate payment system differs from most other prospective payment systems because there is a single product category to define the service Medicare is buying. Although different equipment, supplies, and labor are needed for hemodialysis and peritoneal dialysis, the current system does not differentiate payment based on dialysis method, location (home or incenter) or equipment used.
Phosphate binder use was associated with lower mortality risk but a higher risk of end-stage renal disease (ESRD) among patients with chronic kidney disease (CKD) and high phosphorus levels, according to study findings presented at the National Kidney Foundation's 2015 Spring Clinical Meetings in Dallas.
In a retrospective longitudinal cohort study, Ardeshir Khosraviani, MD, and colleagues at Kaiser Permanente Southern California compared phosphate binder use and non-use among 3,026 non-dialysis CKD patients with hyperphosphatemia (phosphorus levels 5.5 mg/dL or higher). Compared with patients who did not use phosphate binders, those who did had a 15% decreased mortality risk and a nearly 3-fold increased risk of ESRD, the investigators reported.
“These findings underscore the need to better understand whether earlier phosphorus management may impact morbidity and mortality in advanced CKD,” the authors concluded in a poster presentation. Of the 3,026 subjects, 596 used binders and 2,430 did not. Study subjects had a mean age was 65.5 years; 49% were female, 49% were white, 24% were Hispanic, 17.3% were black, and 8.5% were Asian. The binder group had higher rates of diabetes, hypertension, and coronary artery disease.
“Our study raises the question of whether earlier management and control of hyperphosphatemia in the CKD population with binder therapy may improve patient survival in terms of mortality prior to and after [transition to ESRD],” Dr. Khosraviani told Renal & Urology News.
He said he and his colleagues believe their study adds to the literature on the topic because it looked at a real-world practice environment using a large and heterogeneous CKD population, and the results provide insights into CKD mineral-bone management strategies as patients transition to ESRD.
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