New Technologies for Patients with End-Stage Renal Disease: The US Regulatory Perspective

2001 ◽  
pp. 10-22 ◽  
Author(s):  
M.C. Provost ◽  
C.M. Meyers
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
New Technologies ◽  
Regulatory Perspective ◽  
The Us ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Palliation Versus Dialysis for End-Stage Renal Disease in the Oldest Old: What are the Considerations?

2017 ◽  
Vol 10 ◽  
pp. 117822421773508
Author(s):  
Lyle S Walton ◽  
Gregory D Shumer ◽  
Björg Thorsteinsdottir ◽  
Theodore Suh ◽  
Keith M Swetz
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Oldest Old ◽  
Functional Decline ◽  
Symptom Burden ◽  
Vulnerable Population ◽  
Management Approach ◽  
The Us ◽  
Stage Renal Disease ◽  
End Stage

As the US population continues to age, new cases of end-stage renal disease (ESRD) in individuals, aged 85 years or older (the oldest old), are increasing. Many patients who begin hemodialysis despite questionable benefit may struggle with high symptom burden and rapid functional decline. This article reviews the history regarding the funding and development of the Medicare ESRD program, reviews current approaches to the oldest old with ESRD, and considers strategies to improve the management approach of this vulnerable population.

Abstract MP10: Increasing Obesity Prevalence in the United States End-stage Renal Disease Population

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Brittany Shelton ◽  
Deanna McWilliams ◽  
Rhiannon D Reed ◽  
Margaux Mustian ◽  
Paul MacLennan ◽  
...  
Keyword(s):  
United States ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Obesity Prevalence ◽  
The Us ◽  
Prevalence Of Obesity ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Obesity has become a national epidemic, and is associated with increased risk for comorbid diseases including end-stage renal disease (ESRD). Among ESRD patients, obesity may improve dialysis-survival but decreases likelihood of transplantation, and as such, obesity prevalence may directly impact growth of the incident dialysis population. Methods: Incident adult ESRD patients with complete body mass index (BMI, kg/m 2 ) data were identified from the United States Renal Data System from 01/01/1995-12/31/2010 (n=1,822,598). Data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (n=4,303,471) represented the US population when weighted. Trends in BMI and obesity classes I (BMI of 30-34.9), II (BMI of 35-39.9), and III (BMI ≥40) were examined by year of dialysis initiation. Trends in median BMI slope were compared between the ESRD and US populations using linear regression. Results: Median BMI of ESRD patients in 1995 was 24.2 as compared to 28.0 in 2010, a 15.7% increase, while the US population’s median BMI increased from 24.2 in 1995 to 25.6 in 2010, a 5.8% increase. Comparable trends were noted with respect to prevalence of obesity classes I, II, and III (Table). BMI increase among the ESRD population was significantly more rapid than among the US population (β: 0.15, 95% CI: 0.14-0.17, p<0.001) (Figure). Conclusion: The median BMI of ESRD patients and prevalence of obesity among ESRD patients is increasing more rapidly than the US population. Given the increased dialysis-survival and decreased likelihood of transplantation associated with obesity, healthcare costs will likely increase, and thus, future research should be directed at examining medical expenditures.

scholarly journals End-stage renal disease due to lupus nephritis among children in the US, 1995-2006

2011 ◽  
Vol 63 (7) ◽  
pp. 1988-1997 ◽  
Author(s):  
Linda T. Hiraki ◽  
Bing Lu ◽  
Steven R. Alexander ◽  
Tamara Shaykevich ◽  
Graciela S. Alarcón ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The Us ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Prospective payment system and racial/ethnic disparities: a national retrospective observational study in anaemia complication among end-stage renal disease patients in the US

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Nga TQ. Nguyen ◽  
Alexander P. Maxwell ◽  
Michael Donnelly ◽  
Ciaran O’Neill
Keyword(s):  
Native American ◽  
Renal Disease ◽  
Ethnic Groups ◽  
End Stage Renal Disease ◽  
Ethnic Disparities ◽  
Policy Changes ◽  
The Us ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Abstract Background A series of policy changes in 2011 altered reimbursement arrangements and guidance on use of erythropoiesis-stimulating agents for end-stage renal disease (ESRD) patients with anaemia in the US. While the policy changes were principally directed at care delivered in an outpatient setting, these had the potential to affect inpatient care also. This study used HCUP-NIS data (2008–2016) to examine trends in recorded anaemia among ESRD hospitalizations and analyse disparities in inpatient outcomes among ethnic groups following policy changes. Methods The International Classification of Diseases codes were used to identify ESRD admissions, recorded anaemia due to chronic kidney disease (CKD), and to generate an age-adjusted Deyo-Charlson comorbidity index. Linear splines with a knot placed at the time point of policy changes and multivariable logistic regression were used to examine the likelihood of recorded anaemia, adjusted for a range of socio-demographic and clinical covariates. Difference-in-difference analyses investigated the impact of policies on recorded anaemia. Other outcomes included hospital cost, mortality and place of discharge. Results The percentage of inpatient episodes with recorded anaemia arising from CKD increased from 26.2% in 2008 to 50.0% in 2016. Anaemia was more likely to be recorded as a complication of ESRD among minority ethnic groups and Native American admissions, in particular, (OR 1.20, 95%CI 1.15–1.25) relative to White American admissions; and these disparities widened following changes to reimbursement. Minorities were less likely to die in hospital and to be discharged to another healthcare facility, and (with the exception of Black American admissions) they were more expensive to treat. Conclusions Our findings provide evidence of an increase in recorded anaemia consistent with a shift of patients from outpatient to inpatient settings in the wake of changes to reimbursement enacted in 2011. In addition, the study highlights the existence of ethnic disparities that widened after the policy initiated reimbursement changes.

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