Characterizing Hospitalizations of End-Stage Renal Disease Patients on Dialysis and Inpatient Utilization of Erythropoiesis-Stimulating Agent Therapy

BACKGROUND: In 2006, there were over 350,000 patients with end-stage renal disease (ESRD) receiving dialysis therapy. Studies have found that hemoglobin concentrations are often low among dialysis patients after hospital discharge, yet little is known about inpatient anemia treatment. OBJECTIVE: To characterize hospitalizations among patients with ESRD on dialysis, specifically, inpatient utilization of erythropoiesis-stimulating agent (ESA) therapy. METHODS: A cross-sectional, retrospective study of claims data from 5 commercial health plans for the years 2004-2006 was conducted. Inclusion criteria included 1 or more ESRD-specific International Classification of Diseases Ninth Edition (ICD-9) codes, 3 or more ESRD-specific Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) procedures on different days, or 3 or more dialysis ICD-9 codes or CPT/HCPCS dialysis procedures on separate days. ESRD patient and hospital characteristics were outlined. RESULTS: ESRD patients were hospitalized an average of 1.8 times in both 2004-2005 and 2005-2006. The mean +/- SD hospital length of stay (LOS) was 13.3 +/- 20.5 and 12.8 +/- 19.0 days for 2004-2005 and 2005-2006, respectively. For each year, LOS greater than 7 days occurred in 44% of hospitalizations. Many of these patients were admitted for kidney-related comorbidities and ultimately received procedures and services relevant to dialysis care. For each year, ESA utilization was 13% in year 1 and 11% in year 2 across any LOS. For ESRD patients with a 4- to 7-day LOS (the most common LOS), less than 20% received ESA treatment. ESA utilization increased correspondingly with longer hospital LOS (p < 0.001). CONCLUSIONS: Although ESRD patients are commonly hospitalized and claims recognize that kidney-related conditions exist, the utilization of ESAs is low.