Bundling and the DOPPS data

Currently as we bundle along the dialysis treatment and anemia treatment along with IV medications and antibiotics needed for dialysis access care, future is looking at 2014 to possibly include sensipar.  It also appears that there might be a switch to giving more PO vitamin D rather than IV Vitamin D during dialysis as well.
How is this going to affect the patients? Most of our dialysis patients take many medications already.  Asking them to take more PO medications will be a concern.  Lot of these questions will arise. Lot of these questions arose when bundling was first proposed.  Did the renal community do ok with the bundling. Recently at a local NKF meet, Dr. Jay Wish presented the DOPPS data that is freely available on their website at http://www.dopps.org/annualreport/index.htm on different parameters.

Some interesting findings in Anemia and bone disease and hospitalization:
1. Average Hgb has decreased in USA after the June 2011 ESA labeling from 11.4 to mean of 11.2.  IN general, the range is narrowing and very few percentages are >12 and <10.  
2. Sharpest decline was in the patients with Hgb greater than 12g/dl
3. Mean epo dose decreased by 15% from 2010 to 2011 August, greatest happening after June 2011.
4. IV Iron use has risen
5. Serum ferritin levels are rising in some cases, >1200 ng/ml in 11%

Pth/Bone disease
1. No major changes in pth levels, continue to increase ( as bar was raised to 600 from 300)
2. No change in use of sensipar
3. Small units using more PO vitamin D rather then IV vitamin D

Hospitalization rates have increased in last one year( cause unknown)

take a complete look at the PDF on their website.