Sensing Savvy

There are 20 million veterans in the United States. Approximately nine million are enrolled in the Veterans Health Administration (VHA). About six million of these veterans receive their healthcare in one of the VHA facilities. Among the more than 6,000 dialysis units nationwide, there are approximately 70 VHA dialysis centers. Each year, approximately 13,000 veterans transition to renal replacement therapy, mostly for maintenance dialysis. Given this number of VHA dialysis centers and their limited capacity, only 10 percent of all dialysis veterans initiate treatment at a VHA dialysis center.

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 3)

• In 2016, 80% of patients were using a catheter at hemodialysis (HD) initiation.
• At 90 days after the initiation of HD, 69% of patients were still using catheters.
• Arteriovenous (AV) fistula use at HD initiation rose from 12% to 17% between 2005 and 2016.
• The percentage of patients using an AV fistula or with a maturing AV fistula at HD initiation increased from 28.9% to 33% over the same period.
  

(From 2018 USRDA Data Volume 2: ESRD in the United States)

Diabetes mellitus remains the predominant likely underlying cause of treated ESRD worldwide. Nearly 71 percent of the countries that participated in the U.S. Renal Data system report assigned DM as the primary cause for the incidence of treated ESRD and a key contributor to the global burden of kidney disease and ESRD.

Some stats gleaned from the USRDA report:

(Gleaned from 2018 USRDA Data Volume 2: ESRD in the United States)

Incidence is the ratio of total new cases in a population divided by total population. Incidence refers to new cases of the disease in the population in a year.

Incidence rates of treated ESRD have remained relatively stable since 2002-2003 in most high-income countries, but have actually declined by 2 percent to 10 percent in Austria, Finland, Sweden, Scotland, Denmark and Iceland.

Prevalence is the ratio of the total number of patients diagnosed and getting treatment of a disease to the total population. It tells how widespread disease is in a population.

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 2)

Given the high morbidity and mortality of individuals with end-stage renal disease (ESRD) who are receiving dialysis, quality improvement of renal replacement therapies (RRT) initiatives has long been a priority. Notable efforts from the Centers for Medicare & Medicaid Services (CMS) include assessment and reporting of provider performance through Dialysis Facility Reports and Dialysis Facility Compare, as well as the Quality Incentive Program (QIP), which ties Medicare reimbursement to the achievement of selected quality targets.

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 12)

According to the 2018 USRDS Annual Data Report, a total of 1,397,039 ESRD patients died between 2000 and 2015. Their mean age was 68.6 (±13.6) years; 55 percent were male. Overall, 67 percent were White, 27 percent African American, 1 percent American Indian or Alaska Native, 3 percent Asian, 1 percent were Pacific Islander or Native Hawaiian, and 1 percent were of other race or multiracial. Twelve percent were Hispanic, 55 percent were Non-Hispanic White, and 26 percent Non-Hispanic African American. The median cost per person under Medicare Parts A and B were $103,932 over the last year of life, $19,734 over the last 30 days of life, and $7,687 over the last seven days of life.

(Gleaned from the 2018 USRDS Annual Data Report: Volume 1, Chapter 6: www.usrds.org)

A comparison of all children and those with CKD within the 1,970,375 privately insured children in the United States in 2016 indicates that overall, CKD was present in 2.7 cases per 1,000 children. CKD was most common in children under 4 years of age and adolescents age 18 to 21.

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 6)

Kidney transplantation is the renal replacement therapy (RRP) of choice for the majority of patients with end-stage renal disease (ESRD). Successful kidney transplantation is associated with improved survival, improved quality of life, and healthcare cost savings when compared to dialysis. In 2014, the Organ Procurement and Transplantation Network conducted major revisions of the kidney allocation system in order to reduce discards of potentially usable donor kidneys, decrease access disparities, and decrease unrealized life-years from the available organ supply. Changes included the following:

(Gleaned from 2018 USRDA Data Volume 2: ESRD in the United States)

Prevalence is the ratio of the total number of patients diagnosed and getting treatment of a disease to the total population. It tells how widespread a disease is in a population.

(Gleaned from the 2018 USRDS Annual Data Report: Volume 1, Chapter 4: www.usrds.org)

Cardiovascular disease (CVD) remains the leading cause of death in the United States and most other developed countries. It accounts for approximately 39 percent of deaths among those on dialysis. Among patients with chronic kidney disease (CKD), death from CVD is far more common than progression to end-stage renal disease (ESRD). CKD has been identified as an independent risk factor for CVD, and arguably should be recognized as a coronary disease risk equivalent, similar to diabetes mellitus (DM). The complex relationship between CVD and kidney disease is thought to be due to shared traditional risk factors, such as DM, hypertension (HTN), physical inactivity, left ventricular hypertrophy, smoking, family history and abnormal lipid levels in the blood.