Some Dialysis Centers Overtreat Anemia: Study

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There's still some debate about what the optimal levels of treatment should be. Current recommendations from the U.S. Food and Drug Administration suggest that hemoglobin levels (a measure of oxygen-carrying capacity of red blood cells) should be maintained under 12 grams per deciliter (g/dl), but the most recent guidelines from the National Kidney Foundation allow for up to 13 g/dl. Once hemoglobin levels in kidney patients exceed 12 g/dl, the risk of heart attack, stroke, heart failure and blood clots increase, according to the editorial.

"The trials to date indicate that maintaining hemoglobin levels above 12 is not in (kidney patients') long-term interest," said Dr. Daniel Coyne, author of the editorial and a professor of medicine at Washington University School of Medicine, in St. Louis.

Coyne said the National Kidney Foundation will be re-examining its guidelines, beginning this month.

In the new study, Thamer and her colleagues compared the treatment received at nonprofit and for-profit dialysis centers for nearly 160,000 dialysis patients during November and December 2004. Eighty-two percent of those included in the study were treated at for-profit centers.

The researchers found vast differences in the way anemia was treated, depending on the type of center where someone received dialysis, with for-profit facilities administering roughly a third more units of epoetin per week.

Thamer and her colleague, Dennis Cotter, president of Medical Technology and Practice Patterns Institute, believe a better way to reimburse centers for epoetin would be to include it in the standard payment given to centers for dialysis, called the "composite reimbursement." Doing so would take away any potential financial incentive for over-treating a patient, they suggested.

And, while each individual patient needs a varying dose of epoetin to combat anemia, Cotter said, "Reimbursement for (each patient) would be based from a population standpoint," which would average the reimbursement to account for individual variations.

Coyne agreed that tying epoetin payments into the composite reimbursement was a good idea. "Reimbursement needs to be tied to providing dialysis. Right now, we offer perverse incentives where wasting epoetin is beneficial," he said.

More information

To learn more about how anemia develops in people on dialysis, visit the National Institute of Diabetes and Digestive and Kidney Diseases.