title: Trends in patient characteristics and first-year medical costs of older incident hemodialysis patients, 1995-2005.
abstract: BACKGROUND
  Characteristics of patients with chronic kidney disease who survive to end-stage renal disease may change over time, affecting subsequent outcomes and costs. We examined trends in older incident hemodialysis patient characteristics and analyzed first-year post-dialysis therapy initiation medical costs.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All US incident hemodialysis patients aged > or =67 years at dialysis therapy initiation from January 1, 1995, to December 31, 2005, with Medicare Part A and Part B in the prior 2 years.
  
  
  METHODS
  Year of dialysis therapy initiation.
  
  
  RESULTS
  Changes in patient characteristics and first-year costs.
  
  
  METHODS
  Mean and median values for continuous variables and percentages of categorical variables; first-year total medical costs measured per person per year. Observed costs were adjusted using Medicare Price Indices and patient case-mix.
  
  
  RESULTS
  Median age at dialysis therapy initiation increased from 74.9 to 77.0 years from 1995 (n = 19,044) to 2005 (n = 31,796; P < 0.001). Diabetes prevalence increased from 54.2% to 64.1% (P < 0.001). Median estimated glomerular filtration rate increased from 8.0 to 11.2 mL/min/1.73 m(2), and median hemoglobin level increased from 9.4 to 10.2 g/dL. Obesity increased from 8.9% to 22.9% (P < 0.001). First-year observed costs increased by 37.9%; however, inflation-adjusted and case-mix-inflation-adjusted costs were stable. Important adjusters for costs are inability to ambulate/transfer, baseline serum albumin level, primary end-stage renal disease cause, comorbid peripheral vascular disease, and baseline hospital days.
  
  
  CONCLUSIONS
  Population aged > or =67 years at dialysis therapy initiation and results may not generalize to the overall hemodialysis population.
  
  
  CONCLUSIONS
  From 1995 to 2005, incident hemodialysis patients aged > or =67 years became older, sicker, and more obese with significantly increased estimated glomerular filtration rates and hemoglobin levels at dialysis therapy initiation. Increased first-year post-dialysis therapy initiation costs became stable over time after adjustment for price inflation; case-mix-inflation-adjusted costs remained constant, possibly because of mixed changes in patient characteristics.
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN 55404, USA. lmau@cdrg.org
authors.forename: Lih-Wen
authors.initials: LW
authors.lastname: Mau
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.forename: Yang
authors.initials: Y
authors.lastname: Qiu
authors.forename: Haifeng
authors.initials: H
authors.lastname: Guo
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Arneson
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Dunning
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors