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Kidney Week

Abstract: PO1138

Clinical Outcomes Among Dual-Eligible Medicare and Medicaid Dialysis Patients in the United States

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Norton, Jenna M., National Institute of Diabetes and Digestive and Kidney Diseases Division of Kidney Urologic and Hematologic Diseases, Bethesda, Maryland, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Agodoa, Lawrence, National Institutes of Health Office of the Director, Bethesda, Maryland, United States
  • Abbott, Kevin C., National Institute of Diabetes and Digestive and Kidney Diseases Division of Kidney Urologic and Hematologic Diseases, Bethesda, Maryland, United States
Background

Dual Medicare-Medicaid eligible beneficiaries generally live in poverty and account for approximately 28% of the US end-stage kidney disease (ESKD) population, but their clinical outcomes are largely unknown. We compared individual- and dialysis-facility level clinical quality measures and survival between dual-eligible and Medicare-only incident dialysis patients.

Methods

In this retrospective cohort study using the United States Renal Data System, we identified 52,863 patients who had Medicare as the primary payer, initiated on dialysis from January 1, 2016 through December 31, 2016, and followed until June 1, 2018. We incorporated data from the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) and the Centers for Medicare & Medicaid Services (CMS) Dialysis Facility Compare files. We excluded those who were <18 years, transplanted or died within 90 days of dialysis initiation. We conducted multivariable Cox regression with death as the outcome, adjusted for demographic and clinical factors.

Results

The Medicare-primary cohort consisted of 19,819 (37.5%) dual eligible and 33,044 (62.5%) Medicare-only beneficiaries, with median follow-up of 1.8 years. Dual eligibles were more likely to be female, Black, Hispanic and younger than their Medicare-only counterparts (59 ± 15 vs. 66 ± 14 years, p<0.001). At 12 months after dialysis initiation, individual-level quality measures such as hemodialysis treatment time, KT/V, hemoglobin, albumin, calcium, and phosphorus were similar between the 2 groups. However, a slightly greater proportion of dual eligibles were dialyzed via catheter at 12 months compared with Medicare-only patients (47.2 vs. 43.0%, p<0.001). At a facility level, mortality rates, hospitalization rates, standardized infection ratios for bloodstream infection, and total performance scores were similar between the 2 groups. Adjusted analyses demonstrated higher risk of death in dual eligibles compared to Medicare-only patients (hazard ratio 1.29 (95% CI 1.23-1.34, p<0.001).

Conclusion

The Medicare-Medicaid dual eligibility status, as an indicator of poverty, was independently associated with higher mortality, despite similar individual- and facility-level performance measures. Further studies to delineate factors associated with death in this large segment of the ESKD population are needed.