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Background: Major bleeding is common in dialysis-dependent end-stage kidney disease (ESKD). Objectives: To compare healthcare resource utilization (HCRU) and costs of major bleeding events between dialysis and non-dialysis populations. Methods: We identified fee-for-service Medicare beneficiaries aged ≥66 years with a first (index) major bleeding event in 2015-2018. Patients with ESKD receiving in-center hemodialysis (HD) and home dialysis from the US Renal Data System were each compared to patients without ESKD from a 20% Medicare sample. HCRU and cost outcomes were compared using model-based standardization, adjusted for age, sex, and race, during the index major bleeding event and a 1-year follow-up period. Results: Patients receiving in-center HD had index major bleeding hospitalizations that were longer and costlier (adjusted mean differences: 0. 7 days 95% CI, 0. 6-0. 8 and 3. 4K 95% CI, 3. 2K-3. 7K) than those without ESKD. During 1-year follow-up, bleeding-related hospitalizations were more common (adjusted rate difference: 37. 6 per 100 person-years 95% CI, 35. 2-40. 1) and costly (adjusted per-person per-year cost difference: 6. 2K 95% CI, 5. 8K-6. 7K) in patients receiving in-center HD than in those without ESKD. Other than blood transfusions, which were more common in home dialysis than in-center HD (adjusted rates per 100 person-years: 255. 8 95% CI, 241. 8-269. 8 vs 202. 1 95% CI, 199. 2-205. 0), HCRU outcomes were generally similar between the dialysis groups. Conclusion: Patients receiving dialysis had longer and costlier major bleeding hospitalizations and accrued substantially higher costs after 1 year versus those without ESKD. Readmissions were a key driver of higher HCRU and costs in ESKD.
Roetker et al. (Sun,) studied this question.