Table 1.
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.