Ongoing Changes in the US Dialysis Environment – Major changes include implementation of a new bundled payment system over 2011 to 2014 by the Centers for Medicare & Medicaid Services (CMS), as well as revised prescribing information for erythropoiesis-stimulating agents (ESAs) in June 2011.

Most Recent Trends in Care– Over the August 2010 to December 2011 time period, many hemodialysis practices have remained stable; examples include dialysis session length, dialysis dose, and nutritional measures. Trends in the following areas are noted:

Anemia: The most notable decrease in hemoglobin levels has been since the June 2011 ESA label update. The mean hemoglobin level declined by 0.10 g/dL from August 2010 to July 2011 and then by an additional 0.29 g/dL from July to October 2011, before appearing to stabilize. In December 2011, the mean hemoglobin level was 11.09 g/dL (10.94 g/dL in ESA-treated patients). From August 2010 through December 2011, the percentage of patients with hemoglobin greater than 12 g/dL declined from 32 percent to 22 percent, while the percentage with hemoglobin less than 10 g/dL increased from 9 percent to 16 percent, and the percentage with hemoglobin less than 9 g/dL increased from 3.0 percent to 5.2 percent.

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