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Kidney Week

Abstract: TH-PO385

Impact of CMS-Kidney Disease Education Policy on Home Dialysis Rates

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Shukla, Ashutosh M., University of Florida, Gainesville, Florida, United States
  • Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States
  • Mohandas, Rajesh, University of Florida, Gainesville, Florida, United States
  • Ozrazgat-baslanti, Tezcan, University of Florida, Gainesville, Florida, United States
Background

Multiple US and international studies have shown that Kidney disease education (KDE) improves informed selection of home dialysis (HoD) in CKD patients. In 2010, Center for Medicare and Medicaid Services (CMS) approved reimbursement for the KDE services for patients with advanced stage 4 & 5 pre-dialysis CKD. No data is available on the efficacy of this policy change on the patient use of HoD.

Methods

we evaluated the effect of the use of CMS KDE billing code during the pre-dialysis period on the rates of post-ESRD HoD use, and factors associated with HoD use.

Results

Out of 369,938 Medicare enrollees between 2010 and 2014, who were 18 years and older and started dialysis first time after 2010, we identified 3,681 patients (1% of included cohort) in whom KDE services were billed for a total of 6,166 times. KDE services were provided with a median of 218 (25th, 75th:74-462) days prior to the initiation of dialysis therapies. Of the 3,681 KDE recipients, 15% (n=538) used HoD as the initial dialysis modality and 25% (n=903) used HoD at any time after KDE. Twelve percent (n=365) of those initiating dialysis with in-center hemodialysis switched to HoD at a median of 216 (25th, 75th:74-581) days after dialysis initiation. Multivariate logistic regression model showed that younger age, white race, non-diabetes renal disease, employment, absence of congestive heart failure, and atherosclerotic disease, higher MDRD eGFR, albumin>3g/dl, not having a need for assistance with daily activities, prior renal care, and group rather than individual KDE were independently associated with higher odds of HoD therapy. Gender, overall diabetes, cystic kidney disease, BMI, or number of KDE services did not have any impact on the use of HoD therapies.

Conclusion

Despite being recognized by CMS, KDE services are vastly underutilized for the patients with incident ESRD. Use of KDE services is associated with marginal improvements in the HoD rates among incident ESRD patients. A significant proportion of those receiving KDE and using HoD therapy need to initiate with in-center hemodialysis. Better pre-ESRD care coordination may be needed among those who choose HoD but require in-center initiation of dialysis.