Four„Treatment modalities

  • 331 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
331
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
1
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Chapter Four Treatment modalities translated by Walter Arndt Ranier Maria Rilke, “Spring Fragment,” By now the sap returns from the routineness That redistills itself in rooted dark Back to the light, and feeds the limpid greenness Still shying from the wind beneath the bark.
  • 2. The two major therapies for end-stage peritoneal dialysis patients, in contrast, the 2006 distribution renal disease are dialysis and kidney transplantation. During was 63 and 37 percent. Medicare covers only 35 percent of hemodialysis an extracorporeal circuit with a dialysis mem- incident transplant patients; 34 percent have Medicare as brane is used to filter and clean the blood; peritoneal dialysis secondary payor coverage, and 31 percent are covered by uses the body’s own peritoneal cavity to transfer solutes and other insurers. These differences may significantly affect both toxins between the blood and the peritoneal dialysis fluid. patient benefits — particularly those related to prescription The incident hemodialysis population is now nearly eight drugs — and provider revenue streams from services such times larger than in 1978, and in 2006 topped 100,000 pa- dialysis therapy, injectables, treatments and medications for tients for the first time. The number of new peritoneal dialysis transplantation, and diagnostic testing. patients peaked at 9,407 in 1995, and has since fallen to 6,725; Differences in payor distribution continue in the preva- this population now accounts for 6.2 percent of new dialysis lent population, but are less dramatic than those seen with patients, a ratio that continues to decline from its 1982–1985 incident patients. Eighty-four percent of hemodialysis pa- peak of 15 percent. tients have Medicare as their primary payor, compared to As of December 31, 2006, nearly 328,000 patients were 79 and 54 percent of those on peritoneal dialysis and with receiving hemodialysis therapy, 26,082 were on peritoneal a transplant.. dialysis (8.2 percent of the dialysis population), and 151,502 Maps of incident rates by modality illustrate nationwide had a functioning graft. The annual rate of growth has changes since 1995–1996, changes which may reflect the slowed in the prevalent hemodialysis population, from 8.5 recent consolidation of ESRD providers, their varying policies percent in 1996 to 3.9 percent in 2006, while the peritoneal regarding therapy, and their individual likelihoods of using dialysis population has remained quite stable. The greatest dialytic and transplant therapies in the incident population. growth has occurred in the transplant population, which has The rates may also reflect changes in access to organs for increased 5.5–6.0 percent each year since 2001. transplantation. Changes in peritoneal dialysis use, for ex- The number of patients who receive a kidney transplant ample, show distinct geographic patterns that differ from as their first ESRD therapy reached 2,635 in 2006, and since the distribution of the hemodialysis population. Although 1996 has grown an average of 7.3 percent each year. In the there has been a general decline in use of this therapy, shown prevalent population, the number waiting to receive a trans- also in maps of the prevalent population, there continue plant reached nearly 69,000 in 2006, with an annual growth to be notable exceptions, including the Dakotas, Nebraska, of 10.1 percent since 1996, though this rate of change has Oklahoma, Louisiana, Mississippi, and Alabama, where use fallen to 7–8 percent in the last three years. Chapter Seven has increased. presents additional information on the wait-listed dialysis The growing consolidation of providers into larger chains population, including the numbers of active and inactive has long been clear, and two large chains now treat the great patients on the list. majority of dialysis patients in the U.S. In the early 1990s, just In the incident hemodialysis population, Medicare only, one in seven dialysis patients received treatment in a chain- Medicare plus Medicaid, and Medicare under HMOs or man- owned unit; in 2006, the number was nearly seven in ten. aged care plans continue to cover 75 percent of patients, The market share of independent units has been relatively while employer group health plans (EGHPs) and Medicare as stable, at 18–19 percent since 2000; hospital-based units, secondary payor cover the remaining 25 percent. Among new however, are now treating just 11 percent of the prevalent
  • 3. 4.1 II Incident patient counts (USRDS), by first modality incident ESRD patients 125 Hemodialysis (2006: 101,306) 4.2 II Prevalent patient counts (USRDS), by modality December 31 point prevalent ESRD patients Peritoneal dialysis (6,725) Total dialysis (108,219) Number of patients (in thousands) 100 Transplant (2,635) 350 Hemodialysis (2006: 327,754) 75 300 Peritoneal dialysis (26,082) Transplant (151,502) Number of patients (in thousands) OPTN transplant 250 wait-list (68,576) 50 200 25 150 0 100 79 81 83 85 87 89 91 93 95 97 99 01 03 05 50 0 79 81 83 85 87 89 91 93 95 97 99 01 03 05 figure 4.1 incident ESRD patients; peritoneal dialysis counts include CAPD & CCPD only. figure 4.2 December 31 point prevalent patients; peritoneal dialysis counts include CAPD & CCPD only. OPTN was created in 1986. dialysis population. With the use of peritoneal dialysis vary- ing considerably by provider group, further consolidation may raise concerns over modality choice and its relation to provider practices. With peritoneal dialysis long the dominant home therapy, home hemodialysis has received little attention in the past 15 years. Its use peaked in 1985, with 5,817 prevalent patients. A number of government programs, paying home aids to help deliver the therapy, ended soon afterwards, contribut- ing to a steady decline in use until by 2002 there were only 1,756 patients. Now, however, there appears to be renewed interest in the use of daily home therapy. The prevalent population reached 2,455 in 2006, with 838 new individuals starting the therapy in 2005–2006. This renewed interest has been fueled by publication of results for single centers using daily home hemodialysis, and new products are being introduced for the delivery of this therapy. In addition, a highlights table 4.a In 2006, the rate of ESRD incidence reached 330 per million popula- new NIH study is in progress, comparing daily or overnight tion for hemodialysis, 21.9 for peritoneal dialysis, and 8.0 for transplant. figure home hemodialysis to in-center therapy, and testing safety 4.3 Chain-owned dialysis providers continue to increase their market share, and efficacy. Currently, the largest concentration of home treating 64 percent of incident hemodialysis patients in 2006, up from 55 hemodialysis patients is found in Illinois and Florida, with percent in 2000. figure 4.4 Medicare as secondary payor coverage varies by patients in an urban setting accounting for 75 percent of modality, at 10.0, 20.4, and 33.8 percent for hemodialysis, peritoneal dialysis, the prevalent population under treatment. and transplant, respectively. table 4.b The overall rate of ESRD prevalence in During the past decade, then, modality use has changed 2006 reached 1,053 per million population for hemodialysis, 84 for perito- considerably. Hemodialysis is still dominant, while use of neal dialysis, and 487 for transplant. The rate for African Americans reached peritoneal dialysis is concentrated in fewer areas of the 3,979 — nearly six times greater than the rate of 685 among whites, and twice country. Differences in the accumulation of patients on as high as the rate among Native Americans. different modalities need to be carefully considered, not contents only from the vantage point of quality of care, but in terms of payor distribution and incentives, which may influence modality choice and the availability of services. Use of home hemodialysis appears to be resurging, based on new incident modality · 82 counts & rates • patient distribu- applications of daily home therapies such as short treat- tion by first modality & unit type • patient distribu- ments of 2–3 hours as well as overnight therapy 5–6 days tion by payor • geographic variations in incident rates per week. These trends will require increased evaluation prevalent modality · 84 counts & rates • patient distribution in the future. by modality & unit type • patient distribution by payor • geographic variations in prevalent rates home hemodi- alysis · 86 patient demographics • patient distribution by state & by geographic location
  • 4. 82 table 4.a In 2006, nearly 100,000 new ESRD II 4.a Incident counts & rates per million population, 2006, by age, gender, patients began therapy on hemodialysis, race, ethnicity, & primary diagnosis incident ESRD patients; unknowns dropped 6,600 were placed on peritoneal dialysis, and 2,419 received a preemptive transplant Number of patients Rate per million population (these numbers exclude patients with missing HD PD Tx Unk. HD PD Tx Unk. 0-19 643 393 183 12 7.3 4.7 2.2 0.2 demographic information). The rate of ESRD 20-44 11,698 1,200 696 33 108.8 11.2 6.5 0.3 incidence reached 330 per million population Age 45-64 36,738 2,763 1,216 70 566.8 40.9 16.7 1.0 for hemodialysis, 21.9 for peritoneal dialysis, 65-74 23,445 1,297 296 40 1,362.7 71.6 15.5 2.1 and 8.0 for transplant. Considerable differ- 75+ 27,011 947 28 21 1,687.2 54.6 1.5 1.1 ences by race persist in these rates, with the Male 55,548 3,595 1,438 101 415.0 25.7 9.8 0.7 Gen. rate for African Americans beginning ther- Female 43,987 3,005 981 75 263.7 18.8 6.4 0.5 apy on hemodialysis, for example, reaching White 65,024 4,791 1,919 139 251.5 18.9 7.7 0.6 962 per million population, compared to 252 African American 29,496 1,401 203 19 962.2 41.6 5.8 0.6 Race Native American 1,074 70 37 * 449.0 26.5 12.3 * among whites. The incident rate for those Asian 3,941 338 260 15 342.0 26.7 18.3 1.1 receiving a preemptive transplant, in contrast, Hispanic 12,456 720 183 12 492.2 22.8 5.0 0.4 Eth. is greatest in the Asian population, at 18.3 Non-Hispanic 87,079 5,880 2,236 164 316.4 21.7 8.4 0.6 per million population, compared to 12.3, 7.7, Diabetes 44,901 2,699 521 36 148.4 8.9 1.7 0.1 and 5.8 among Native Americans, whites, and Primary diagnosis Hypertension 27,700 1,462 239 19 91.8 4.9 0.8 0.1 African Americans, respectively. Glomerulonephritis 6,463 885 480 18 21.4 3.0 1.6 0.1 Cystic kidney 1,804 403 394 21 6.0 1.3 1.3 0.1 Other urologic 1,477 93 58 * 4.9 0.3 0.2 * Other cause 12,280 803 481 41 40.8 2.7 1.6 0.1 Unknown/missing 4,910 255 246 36 8.1 0.4 0.4 0.1 All 99,535 6,600 2,419 176 329.5 21.9 8.0 0.6 figure 4.3 Chain-owned dialysis providers II 4.3 Incident patient counts, by first modality continue to increase their market share, & unit type incident dialysis patients treating 64 percent of incident hemodialy- Hemodialysis Peritoneal dialysis sis patients in 2006, up from 55 percent in 75 5 Number of patients (in thousands) 2000. This change is concurrent with a fall Chain 60 Non-chain 4 in the number of new hemodialysis patients Hospital-based treated in hospital-based units, from 21 to 15 Unknown 45 3 percent. The percentage of incident perito- neal dialysis patients treated in chain-owned 30 2 units, in contrast, has remained stable for several years, and with the recent sale of the 15 1 providers most likely to employ this modal- ity (Gambro has been purchased by DaVita, 0 0 89 91 93 95 97 99 01 03 05 89 91 93 95 97 99 01 03 05 and RCG by Fresenius), future use of this therapy is in question.
  • 5. 4 incident 2008 USRDS ANNUAL DATA REPORT modality 4.5 II Geographic variations in unadjusted incident rates (per IIESRD treatment modalities 83 million population), by first modality & HSA incident ESRD patients II 4.4 Incident patient distribution, by first Hemodialysis: 1995–1996 Hemodialysis: 2005–2006 modality & payor incident ESRD patients 100 Hemodialysis 80 60 Other/unknown 40 Medicare secondary payor Medicare HMO 20 Medicare & Medicaid 167 243 278 321 386 421 206 243 278 321 386 455 Medicare 0 Peritoneal dialysis: 1995–1996 Peritoneal dialysis: 2005–2006 Peritoneal dialysis 100 80 Percent of patients 60 40 20 13.8 17.4 21.3 25.8 32.6 51.9 13.7 17.4 21.3 25.8 32.6 42.9 0 Transplant 100 Transplant: 1995–1996 Transplant: 2005–2006 80 60 40 20 0 78 82 86 90 94 98 02 06 2.58 4.65 5.97 7.34 9.58 13.14 3.80 4.65 5.97 7.34 9.58 14.51 figure 4.4 Nearly one in two new hemodialysis figure 4.5 The choice of initial modality continues to vary across the country. The incident rate patients is covered solely by Medicare, 14.4 for patients beginning ESRD therapy on hemodialysis, for example, is greatest on the East percent are dually-enrolled (Medicare/Med- Coast and in the southeastern states, while the rate for patients with a preemptive transplant icaid), and 11.5 percent are covered by a Medi- is highest in the Upper Midwest. In the 2005–2006 hemodialysis population, the mean rate care HMO provider — up from 8.7 percent in in the upper quintile is 2.5 times greater than in the lower; regions with the highest transplant 2005. Medicare covers 45.4 and 27.8 percent, rates have a mean rate 3.8 times greater than those with the lowest. respectively, of peritoneal dialysis and trans- plant patients, while 10.4 and 4.7 percent are table 4.a incident ESRD patients; unknowns dropped. Rates by age dually-enrolled and 7.2 and 2.8 percent have adjusted for gender & race, rates by gender adjusted for age & race, HMO coverage. Medicare as secondary payor rates by race & ethnicity adjusted for age & gender, & rates by coverage also varies by modality, at 10.0, 20.4, primary diagnosis adjusted for age, gender, & race. *Values for cells with ten or fewer patients are suppressed. figure 4.3 incident dialysis and 33.8 percent for hemodialysis, peritoneal patients; peritoneal dialysis includes CAPD & CCPD only. figure 4.4 dialysis, and transplant, respectively. incident ESRD patients; peritoneal dialysis includes CAPD & CCPD only. figure 4.5 incident ESRD patients, by HSA, unadjusted. Excludes patients residing in Puerto Rico & the Territories. For details on how to read the map legends, please see page xvi in the Introduction.
  • 6. 84 table 4.b At the end of 2006, nearly 320,000 II 4.b Prevalent counts & rates per million population, 2006, by age, gender, ESRD patients were receiving hemodialysis race, ethnicity, & primary diagnosis December 31 point prevalent ESRD patients therapy, 25,438 were being treated with peri- toneal dialysis, and 147,389 had a functioning Number of patients Rate per million population graft (these numbers exclude patients with HD PD Tx Unk. HD PD Tx Unk. 0-19 1,201 815 5,001 57 13.4 9.6 59.4 0.6 missing demographic information). Patients 20-44 44,656 5,633 43,043 269 415.7 52.7 403.8 2.5 age 45–64 constitute the largest portion of Age 45-64 130,134 11,229 75,877 391 2,012.8 163.2 1,054.8 5.6 the prevalent population by age, from 41 per- 65-74 72,921 4,667 19,515 89 4,361.2 259.5 1,074.8 4.9 cent of those on hemodialysis to 52 percent 75+ 71,050 3,094 3,953 29 4,569.5 179.2 212.8 1.7 of those with a transplant. The overall rate Male 174,899 13,311 87,353 488 1,288.5 94.6 597.1 3.4 Gen. of ESRD prevalence in 2006 reached 1,053 Female 145,063 12,127 60,036 347 867.2 75.9 385.4 2.2 per million population for hemodialysis, 84 White 176,940 16,787 110,267 542 684.6 66.1 440.6 2.2 for peritoneal dialysis, and 487 for transplant. African American 124,184 6,743 28,213 236 3,978.9 195.9 822.4 6.6 Race Native American 4,809 330 1,537 11 2,000.1 124.7 562.6 3.9 The rate for African Americans, however, Asian 14,029 1,578 7,372 46 1,184.0 119.6 524.5 3.3 reached 3,979 — nearly six times greater than Hispanic 44,578 2,903 16,917 119 1,717.8 93.5 511.6 3.4 Eth. the rate of 685 among whites, and twice as Non-Hispanic 275,384 22,535 130,472 716 1,001.6 83.3 488.5 2.7 high as the rate among Native Americans. Diabetes 140,630 8,568 34,323 185 462.1 28.2 113.1 0.6 Primary diagnosis Hypertension 91,440 6,173 22,563 127 300.9 20.4 74.2 0.4 Glomerulonephritis 33,241 4,615 40,067 204 109.7 15.3 132.4 0.7 Cystic kidney 7,969 1,340 13,947 56 26.2 4.4 45.8 0.2 Other urologic 6,896 634 5,508 29 22.8 2.1 18.3 0.1 Other cause 27,622 3,062 21,301 159 91.3 10.2 70.7 0.5 Unknown/missing 12,164 1,046 9,680 75 20.1 1.7 16.0 0.1 All 319,962 25,438 147,389 835 1,053.1 83.9 486.6 2.8 figure 4.6 Between 2000 and 2006, the per- II 4.6 Prevalent patient counts, by modality & unit centage of prevalent patients treated by chain- type December 31 point prevalent dialysis patients owned providers rose from 58.1 to 66.4 per- Hemodialysis Peritoneal dialysis cent for hemodialysis, and from 54.8 to 64.9 250 20 Number of patients (in thousands) for peritoneal dialysis. Hospital-based units, Chain 200 Non-chain in contrast, now treat just 11.4 and 13.2 per- 15 Hospital-based cent of prevalent hemodialysis and peritoneal Unknown 150 dialysis patients, down from 18.1 and 21.5 per- 10 cent in 2000. This year the USRDS acquired 100 new cross-reference data that allow us to iden- 5 tify units that were previously missing their 50 hospital-based designation, and to update our patient counts for these units. Numbers in 0 0 89 91 93 95 97 99 01 03 05 89 91 93 95 97 99 01 03 05 this figure, and in Figure 4.3, thus differ from those presented in previous ADRs.
  • 7. 4 prevalent 2008 USRDS ANNUAL DATA REPORT modality 4.8 II Geographic variations in unadjusted prevalent rates (per million IIESRD treatment modalities 85 population), by modality & HSA December 31 point prevalent ESRD patients II 4.7 Prev. pt distribution, by modality Hemodialysis: 1996 Hemodialysis: 2006 & payor Dec. 31 point prevalent ESRD pts 100 Hemodialysis 80 60 Other/unknown 40 Medicare secondary payor Medicare HMO 20 Medicare & Medicaid 382 512 634 762 1,006 1,259 432 512 634 762 1,006 1,467 Medicare 0 Peritoneal dialysis: 1996 Peritoneal dialysis: 2006 Peritoneal dialysis 100 80 Percent of patients 60 40 20 0 53.5 68.4 86.8 103.2 126.5 164.3 51.5 68.4 86.8 103.2 126.5 167.6 100 Transplant Transplant: 1996 Transplant: 2006 80 60 40 20 0 78 82 86 90 94 98 02 06 281 333 361 390 433 470 319 333 361 390 433 530 figure 4.7 Nine in ten prevalent hemodialysis figure 4.8 Rates by modality in the prevalent ESRD population show the same general patterns patients had some type of Medicare cover- as those for incident patients. The rate for hemodialysis patients is greatest in the south and age in 2006; 43 percent were covered only southeastern portions of the country, while for patients with a functioning graft the rates by Medicare, while one-third were dually- are greatest in the northern states. In the 2006 hemodialysis population, the mean rate in enrolled in both Medicare and Medicaid — a the upper quintile was 3.3 times higher than in the lower; regions with the highest transplant number varying little since the mid-1990s. rates have a mean rate just 1.7 times greater than those with the lowest. Medicare also covers nine of ten peritoneal dialysis patients, though 50 percent are cov- ered solely by Medicare, and just 24 percent table 4.b December 31 point prevalent ESRD patients; unknowns dropped. Rates by age adjusted for gender & race, rates by gender adjusted for age are dually-enrolled. In the transplant popu- & race, rates by race & ethnicity adjusted for age & gender, & rates by lation, in contrast, just 34 percent are cov- primary diagnosis adjusted for age, gender, & race. figure 4.6 December ered by Medicare alone. Transplant patients 31 point prevalent dialysis patients; peritoneal dialysis includes CAPD younger than 65 and not disabled lose their & CCPD only. figure 4.7 December 31 point prevalent ESRD patients; peritoneal dialysis includes CAPD & CCPD only. figure 4.8 December 31 entitlement three years after the transplant. point prevalent ESRD patients, by HSA, unadjusted. Excludes patients residing in Puerto Rico & the Territories. For details on how to read the map legends, please see page xvi in the Introduction.
  • 8. II 4.c Home hemodialysis: incident patient distribution inc. home HD pts, 2005–2006 Column figure 4.9 Illinois and Florida accounted for 56 percent of the incident home hemodialysis 86 Total percent 0-19 . . population in 2005–2006, with 29.4 and 26.3 20-44 95 11.3 percent, respectively. Eight percent of patients Age 45-64 271 32.3 receiving home hemodialysis therapy resided 65-74 165 19.7 in Ohio, and 3–4 percent in Texas, Georgia, 75+ 307 36.6 California, New York, and Michigan. Male 472 56.3 Gen. Female 366 43.7 White 551 65.8 II 4.9 Percentage of inc. home HD pts in the top 10 states inc. home HD pts, 05–06 African American 257 30.7 Race Native American * 0.1 30 Asian 20 2.4 Percent of U.S. home HD patients Other/unknown * 1.1 25 Hispanic 81 9.7 Eth. table 4.c Of the 838 patients beginning ESRD Non-Hispanic 757 90.3 20 therapy on home hemodialysis in 2005–2006, Diabetes 302 36.0 nearly one-third were age 45–64, and 37 per- 15 Primary diagnosis Hypertension 290 34.6 cent were age 75 and older. Fifty-six percent Glomerulonephritis 43 5.1 10 of these new patients were male, two in three Cystic kidney 15 1.8 were white, and one in ten was Hispanic. Pri- Other urologic 13 1.6 5 mary diagnoses of diabetes and hyperten- Other cause 86 10.3 0 sion each accounted for 35–36 percent of the Unknown/missing 89 10.6 IL FL OH TX GA CA NY MI TN MD population. All 838 100.0 figure 4.10 New ESRD patients treated with II 4.10 Incident dialysis patients, by modality II 4.11 Incident home HD patients, by home hemodialysis therapy are far more & assistance incident dialysis patients, 2006 geographic location incident home HD pts likely to be receiving assistance (see caption for definition) than those treated with center 100 100 Urban hemodialysis or with peritoneal dialysis. In 80 80 2006, 57 percent of incident home hemodi- Percent of patients Percent of patients alysis patients were on assistance, compared 60 60 to 16 and 5 percent, respectively, of those on center hemodialysis and peritoneal dialysis. 40 40 These data may seem to imply that home hemodialysis patients are astonishingly 20 Assistance 20 Rural disabled. Many of those classified as home No assistance Unknown patients, however, may be institutionalized 0 0 Center HD Home HD PD All 78 82 86 90 94 98 02 06 and receive their dialysis in the nursing home setting. figure 4.11 In 2006, the percentage of incident home hemodialysis patients living in urban locations reached 87 percent, up from 62 per- cent in 1992. The percentage living in rural locales, in contrast, fell from 35 percent in 1992 to just 9.9 percent in 2006.
  • 9. 4 home 2008 USRDS ANNUAL DATA REPORT hemodialysis II 4.d Home hemodialysis: prevalent patient distribution prev home HD patients, 2006 Column table 4.d Of the nearly 2,500 prevalent patients treated with home hemodialysis in 2006, 44 IIESRD treatment modalities percent were age 45–64, and six in ten were 87 Total percent 0-19 21 0.9 male. Sixty-six percent were white, and just 20-44 494 20.1 6.4 percent were Hispanic. And primary diag- noses of diabetes and hypertension accounted Age 45-64 1,084 44.2 65-74 462 18.8 for 30 and 27 percent, respectively, of the prev- 75+ 394 16.0 alent home hemodialysis population. Male 1,479 60.2 Gen. Female 976 39.8 White 1,614 65.7 II 4.12 Percentage of prv. home HD pts in the top 10 states prv. home HD patients, 2006 African American 754 30.7 Race Native American 12 0.5 20 Asian 65 2.6 Percent of U.S. home HD patients Other/unknown * 0.4 Hispanic 156 6.4 15 Eth. Non-Hispanic 2,299 93.6 Diabetes 737 30.0 10 Primary diagnosis Hypertension 661 26.9 Glomerulonephritis 457 18.6 Cystic kidney 133 5.4 5 figure 4.12 Seventeen percent of prevalent Other urologic 84 3.4 home hemodialysis patient in 2006 lived in Other cause 290 11.8 0 Illinois, while Florida, Texas, and Califor- Unknown/missing 93 3.8 IL FL TX CA NY OH GA VA WA MO nia accounted for 8.5, 7.8, and 6.5 percent, All 2,455 100.0 respectively. II 4.13 Prevalent dialysis patients, by modality II 4.14 Prevalent home HD patients, by figure 4.14 The percentage of prevalent home & assistance prev. dialysis patients, 2006 geographic location prev. home HD pts hemodialysis patients residing in urban loca- tions has been rising slowly since the late 100 100 1980s, and reached 74 percent in 2006. This growth has been paralleled by a decline in the 80 80 Urban rural location, which is now at 24 percent. Percent of patients Percent of patients 60 60 40 40 Rural 20 Assistance 20 No assistance Unknown 0 0 Center HD Home HD PD All 78 82 86 90 94 98 02 06 figure 4.13 Differences by modality in the per- centage of patients receiving assistance are table 4.c & figure 4.9 incident home hemodialy- sis patients, 2005–2006 combined. *Values for less striking in the prevalent population than cells with ten or fewer patients are suppressed. among incident patients. In 2006, 10 percent “.” Zero values in this cell. figure 4.10 incident of prevalent home hemodialysis patients were dialysis patients, 2006. Peritoneal dialysis con- sists of CAPD & CCPD only. figure 4.11 incident on assistance, compared to 6 percent of those home hemodialysis patients. table 4.d & figure 4.12 on center hemodialysis and 2 percent of those December 31 point prevalent home hemodialy- treated with peritoneal dialysis. sis patients, 2006. figure 4.13 December 31 point prevalent dialysis patients, 2006. Peritoneal dialy- sis consists of CAPD & CCPD only. figure 4.14 December 31 point prevalent home hemodialysis patients. • In figures 4.10 & 4.13, assistance is defined as a patient who has any one of the fol- lowing pre-existing conditions, as identified on the Medical Evidence form: inability to ambulate, inability to transfer, needs assistance with daily activities, institutionalized, assisted living, nursing home, or other institution.
  • 10. chapter summary 108 2635 thousand Patients beginning ESRD therapy on dialysis in 2006 (4.1) Patients beginning ESRD therapy with a transplant in 2006 (4.1) 328 26 152 69 88 thousand thousand thousand thousand Prevalent patients on Prevalent patients on Prevalent patients with a Patients wait-listed for a hemodialysis, 2006 (4.2) peritoneal dialysis, 2006 (4.2) transplant, 2006 (4.2) kidney transplant, 2006 (4.2) 962 42 5.8 64% African American African American African American 2006 449 27 12.3 5.5 times Native American Native American Native American higher 342 27 18.3 Asian Asian Asian 252 19 7.7 12% 14.4 10.4 4.7 White White White 1989 HD Tx PD Rate of new ESRD pts starting Rate of new ESRD pts starting Rate of new ESRD pts starting Incident hemodialysis Incident patients dually- therapy on hemodialysis in therapy on peritoneal dialysis therapy with a transplant in patients treated in enrolled in Medicare/Medicaid, 2006 (per million pop.; 4.a) in 2006 (per million pop.; 4.a) 2006 (per million pop.; 4.a) chain-owned units (4.3) 2006 (%, 4.4) 3979 196 822 66% African American African American African American 2006 2000 125 563 4.7 times Native American Native American Native American higher 1184 120 525 Asian Asian Asian 685 66 441 14% 33 24 15 White White White 1989 HD Tx PD Prevalent ESRD patients on Prevalent ESRD patients on Prevalent ESRD patients with Prevalent hemodialysis Prevalent patients dually- hemodialysis in 2006 (per peritoneal dialysis in 2006 a functioning transplant in patients treated in enrolled in Medicare/Medicaid, million population; 4.b) (per million population; 4.b) 2006 (per million pop.; 4.b) chain-owned units (4.6) 2006 (%, 4.7) 410 in Prevalent U.S. home HD pts treated in Illinois, Florida, Texas, or California (4.13)