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. 2020 Aug 14;1(10):1137–1142. doi: 10.34067/KID.0001602020

Table 1.

Clinical dialysis practice and its financing in the United States

Measures Statistics Reference
Epidemiology of patients on dialysis
 Total patients with ESKD in the United States in 2017 Incident patients: 124,500 (370.2 per million per year) 2019 USRDS ADR (4)
Prevalent patients: 746,557 (2203.5 per million per year)
 Number of patients on dialysis (per million people in the general population), total (HD versus PD, 2017) Incident patients: 359.3 (232.0 versus 37.4) 2019 USRDS ADR (4)
Prevalent patients: 1545.8 (1381.6 versus 155.6)
 Percent of patients with ESKD on home dialysis (2017) Incident patients: 11% 2019 USRDS ADR (4)
Prevalent patients: 8%
 Primary cause of ESKD in incident patients on dialysis, total (HD versus PD, 2017) Diabetes: 47% (48% versus 44%) 2019 USRDS ADR (4)
Hypertension: 29% (30% versus 28%)
GN: 7% (6% versus 13%)
Cystic kidney: 3% (2% versus 6%)
Other/Unknown: 14% (14% versus 8%)
 Standardized mortality rate, total (HD versus PD versus transplant, 2017) 134 (167 versus 156 versus 29) per 1000 patient-yr 2019 USRDS ADR (4)
 Hospitalization, HD versus PD, 2016 1.7 versus 1.7 per patient-yr 2018 USRDS ADR (1)
 Proportion of readmission within 30 d of discharge, HD versus PD, 2016 38% versus 37% 2018 USRDS ADR (1)
 Emergency department visit, HD versus PD, 2016 3.0 versus 2.3 per patient-yr 2018 USRDS ADR (1)
 Observation stay, HD versus PD, 2016 0.4 versus 0.2 per patient-yr 2018 USRDS ADR (1)
Pre-ESKD care
 Proportion of receiving pre-ESKD nephrology care >12 mo: 33% 2019 USRDS ADR (4)
6–12 mo: 20%
0–6 mo: 14%
None: 19%
Unknown/missing: 14%
 Clinical characteristics by pre-ESKD nephrology care, >12 mo versus none Dietary care: 13% versus 0.3% 2019 USRDS ADR (4)
Erythropoiesis-stimulating agent use: 22% versus 2%
AV fistula: 24% versus 2%
Central venous catheter: 52% versus 93%
eGFR <5 ml/min per 1.73 m2: 12% versus 20%
 Vascular access in patients on HD (2018) AV fistula: 63% 2019 USRDS ADR (4)
AV graft: 18%
Central venous catheter 20%
Provision of care
 Average FTE Physician FTEs: 0.05±0.47 Shreay et al. (5)
Nursing FTEs: 4.24±3.59
Technician FTEs: 6.01±4.68
Other clinical FTEs: 0.70±1.81
 Average length of a dialysis session 216.5±26.1 min Flythe et al. (6)
 Frequency of being seen by nephrologist during dialysis sessions <4 times per mo: 32% Kawaguchi et al. (7)
4 times per mo: 51%
>4 times per mo: 17%
 Type of dialysis units in 2020 Profit: 89% US Centers for Medicare and Medicaid Services (8)
Nonprofit:11%
 Distribution of patients by unit affiliation in 2011 (proportion) Hospital based: 9% (13%) 2013 USRDS ADR (9)
Large dialysis organizations: 63% (66%)
Independent units: 14% (13%)
Small dialysis organizations: 14% (12%)
Financing of dialysis
 Percent of insurance coverage All patients with ESKD are eligible to Medicare coverage Rettig (10)
 Government financing versus private insurance financing: Dominant payer: Medicare, as a federal health insurance program National Institute of Diabetes and Digestive and Kidney Diseases (11)
Other payers: Medicaid, Veterans Affairs, private insurers, and other assistance programs
 Regulations in dialysis financing January 2011: Implementation of the ESRD Prospective Payment System
January 2012: Implementation of ESRD Quality Incentive Program
October 2015: Implementation of Dialysis Facility Compare program (star ratings)
October 2015: Implementation of the Comprehensive ESRD Care Model by the creation of ESRD Seamless Care Organizations
July 2019: Launch of the federal executive order Advancing American Kidney Health
 Reimbursement per dialysis session in USD Base rate: $239.33 2020 CMS Prospective Payment System (12)
 Medicare expenditure Total: $46.6 billion 2019 USRDS ADR (4)
Medicare fee-for-service plan: $35.9 billion
Medicare advantage plan: $10.7 billion
 Medicare per person per year spending in 2017 HD: $91.795 2019 USRDS ADR (4)
PD: $78,159
Transplant: $35,817

USRDS, United States Renal Data System; ADR, Annual Data Report; HD, hemodialysis; PD, peritoneal dialysis; AV, arteriovenous; FTE, full-time employment; CMS, Centers for Medicare and Medicaid Services.