Dialysis facility type may affect epoetin therapy

NEW YORK (Reuters Health) - The organization status and ownership of a dialysis facility appears to influence the dose of epoetin that patients with anemia are given, new research suggests. Specifically, the study results indicate that bigger "for-profit" chain facilities use larger dose adjustments and aim for higher hematocrit levels, which indicate levels of red blood cells, compared with nonprofit facilities.

"These findings suggest that reimbursement policy and clinical performance measures may provide incentives for dialysis facilities, in particular for-profit facilities, to target hematocrit levels exceeding those recommended by the clinical guidelines," the researchers report in the Journal of the American Medical Association.

Epoetin therapy for anemia in patients undergoing dialysis is the single biggest Medicare drug expenditure, "totaling $1.8 billion in 2004," add Dr. Dennis Cotter, from the Medical Technology and Practice Patterns Institute in Bethesda, Maryland, and colleagues.

Patients with kidney failure who require dialysis often develop anemia. Kidney failure patients often have low levels of the hormone erythropoietin, which is involve in the development of red blood cells, and they may also experience blood loss during dialysis. Epoetin, sold under the trade names Epogen and Procrit, is a drug commonly used to treat anemia in these patients by raising red blood cell levels.

In a related editorial, Dr. Daniel W. Coyne, from Washington University School of Medicine in St. Louis, comments that "this report comes at an opportune time given the recent US Food and Drug Administration advisory warning that epoetin and darbepoetin result in a 'an increased number of deaths and of non-fatal heart attacks, strokes, heart failure, and blood clots when...adjusted to maintain...hemoglobin more than 12 g/dL."

To investigate whether the type of dialysis facility affects epoetin dosing, Dr. Dennis Cotter, from the Medical Technology and Practice Patterns Institute in Bethesda, Maryland, and colleagues analyzed data from 159,522 patients who received hemodialysis between November and December 2004.

Regardless of anemia status, patients at large for-profit dialysis chain facilities received higher epoetin doses than did those at nonprofit facilities. On average, the larger facilities administered an extra 3306 units of epoetin per week.

In patients with hematocrit levels of less than 33 percent, for-profit facilities raised epoetin doses threefold compared with nonprofit facilities. Large for-profit facilities also increased the doses in patients with hematocrit levels in the target range of 33 percent to 36 percent.

SOURCE: Journal of the American Medical Association, April 18, 2007.