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Kidney Week

Abstract: PO0799

Real-World Use of Phosphate Binder Agents Among Dialysis-Dependent Patients with CKD in Medicare Fee-for-Service

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Szabo, Erika, Akebia Therapeutics Inc, Cambridge, Massachusetts, United States
  • Ferro, Christine, Milliman USA, New York, New York, United States
  • Dieguez, Gabriela, Milliman USA, New York, New York, United States
  • Metz, Steve, Milliman USA, New York, New York, United States
  • Moore, Jennifer, Akebia Therapeutics Inc, Cambridge, Massachusetts, United States
  • Berner, Todd, Akebia Therapeutics Inc, Cambridge, Massachusetts, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Phosphate binders (PBs) are prescribed to control hyperphosphatemia among patients with chronic kidney disease. The need for phosphate intervention peaks among those with dialysis-dependent (DD) end-stage renal disease (ESRD). We used Centers for Medicare & Medicaid Services 100% Research Identifiable Files (RIF) data, representing 100% of Medicare fee-for-service beneficiaries, to characterize contemporary PB utilization among established and incident patients with DD ESRD across dialysis modalities.


We identified incident and prevalent patients with DD ESRD in the 2018-2019 RIF data, separating hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), or continuous cycling peritoneal dialysis (CCPD) patients based on frequency of revenue codes. We assessed monthly PB use for calcium acetate, ferric citrate, lanthanum carbonate, sevelamer (hydrochloride and carbonate) and sucroferric oxyhydroxide. PB use was defined as a filled prescription covering 15+ days in a calendar month.


We identified 233,564 patients with DD ESRD, of which 10% were incident. These patients reported 2,439,804 outpatient dialysis months in 2019. Among all patients, 28.4% did not report PB use in 2019 (26.4% among prevalent patients and 46.6% among incident patients). Among patients with any PB use, the average number of outpatient dialysis months was 10.9, of which 6.4 (60%) reported PB use. Average months with PB use were 3.8 for CAPD, 5.3 for CCPD, and 6.4 for hemodialysis.


We found gaps in PB use among patients receiving outpatient dialysis who were also prescribed a binder in 2019. Binder use was reported in 60% of all outpatient dialysis months for patients in our study, suggesting that PBs may have been underutilized or required only intermittently. Further studies are needed to determine the reasons for gaps in PB use and to identify opportunities for control of phosphate levels among patients with DD ESRD.


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