US Renal Data System 2013 Annual Data Report

This 25th US Renal Data System (USRDS) Annual Data Report contains data through 2011, and again examines chronic kidney disease (CKD) in the United States, characterizing its burden in the general population. In the first section, we offer important data on the impact of CKD, and use the CKD staging system as a predictor of morbidity and mortality. We also compare hospitalization and rehospitalization rates and evaluate adverse events and interventions associated with cardiovascular disease. And we continue to report Medicare Part D prescription drug use, acute kidney injury (AKI), and costs associated with CKD.The second section focuses on end-stage renal disease (ESRD). At the end of 2011, 615,899 dialysis and transplant patients were receiving treatment for ESRD—a 3.2% increase from 2010. There were 115,643 new cases of ESRD reported; this was a 1.5% decrease from 2010 and the first decline in actual counts of new ESRD patients over the last 30 years. Total Medicare costs rose 5% in 2011, to $549 billion, while costs for ESRD reached $34.3 billion, accounting for 6.3% of the Medicare budget and an increase of 5.4% from 2010. Data now show similar reductions in mortality rates among patients of all vintages, and there is continued progress in the first year of hemodialysis therapy. Expanded data on rehospitalization after a prior discharge show that 36% of hemodialysis patients are rehospitalized within 30 days of discharge, a number substantially higher than rates found in the general Medicare and CKD populations. Of particular concern are rates of hospitalization for infection in the hemodialysis population, which have increased 43% since 1993. We continue our evaluation of major changes occurring after the start of the bundled Prospective Payment System in January 2011, looking at providers switching to the new system, at pre- and post-bundle changes in the use of erythropoietin, intravenous iron, and vitamin D, and at changes in hemoglobin levels and trends in transfusion events. This 25th US Renal Data System (USRDS) Annual Data Report contains data through 2011, and again examines chronic kidney disease (CKD) in the United States, characterizing its burden in the general population. In the first section, we offer important data on the impact of CKD, and use the CKD staging system as a predictor of morbidity and mortality. We also compare hospitalization and rehospitalization rates and evaluate adverse events and interventions associated with cardiovascular disease. And we continue to report Medicare Part D prescription drug use, acute kidney injury (AKI), and costs associated with CKD. The second section focuses on end-stage renal disease (ESRD). At the end of 2011, 615,899 dialysis and transplant patients were receiving treatment for ESRD—a 3.2% increase from 2010. There were 115,643 new cases of ESRD reported; this was a 1.5% decrease from 2010 and the first decline in actual counts of new ESRD patients over the last 30 years. Total Medicare costs rose 5% in 2011, to $549 billion, while costs for ESRD reached $34.3 billion, accounting for 6.3% of the Medicare budget and an increase of 5.4% from 2010. Data now show similar reductions in mortality rates among patients of all vintages, and there is continued progress in the first year of hemodialysis therapy. Expanded data on rehospitalization after a prior discharge show that 36% of hemodialysis patients are rehospitalized within 30 days of discharge, a number substantially higher than rates found in the general Medicare and CKD populations. Of particular concern are rates of hospitalization for infection in the hemodialysis population, which have increased 43% since 1993. We continue our evaluation of major changes occurring after the start of the bundled Prospective Payment System in January 2011, looking at providers switching to the new system, at pre- and post-bundle changes in the use of erythropoietin, intravenous iron, and vitamin D, and at changes in hemoglobin levels and trends in transfusion events. Support: Funding for the USRDS Coordinating Center is provided under contract to the Minneapolis Medical Research Foundation (MMRF; NIH contract HHSN 267 2007 15002C/NO1-DK-7-5002). Financial Disclosure: Relevant financial interests for contributors to the supplement are listed on page e4.