In this issue of JAMA Internal Medicine, Wang and colleagues1 report on the clinical outcomes of 2 major changes in the care of patients in the United States with end-stage renal disease (ESRD), both of which occurred in 2011. First, the Centers for Medicare and Medicaid Services (CMS) required reimbursement of dialysis with a bundled comprehensive payment system, which includes the cost of erythropoiesis-stimulating agents (ESAs). Second, the US Food and Drug Administration (FDA) revised the prescribing information for ESAs, advising more conservative dosing for patients with chronic kidney disease and strengthening warnings about the increased risk of serious cardiovascular events and death when the ESA dose was targeted to achieve a hemoglobin level of greater than 11 g/dL (to convert to g/L, multiply by 10.0).
Steinbrook R. Lower Erythropoietin Doses and Medicare Payment Reform: Win-Wins for Patients With End-stage Renal Disease. JAMA Intern Med. 2016;176(12):1749–1751. doi:10.1001/jamainternmed.2016.6527
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