Potential Disparities in Home Dialysis Use

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An analysis presented at ASN’s Kidney Week 2023 found lower rates of home dialysis utilization among Medicare dual eligibles compared to non-dual eligibles.

In an analysis presented at the American Society of Nephrology’s (ASN) Kidney Week 2023, Avalere examined potential disparities across socioeconomic status within rates of home dialysis utilization. Beginning with the Advancing American Kidney Health initiative in 2019, the federal government has placed a spotlight on enhancing the prevention and treatment of kidney disease, including introducing new incentives for home dialysis use for patients who require renal replacement therapy. Although this remains an important focus area, access to kidney care services—let alone optimal services—remains a key barrier in this disease area. In the analysis, Avalere hypothesized that patients with lower socioeconomic status may have lower use of home dialysis due to patient access considerations and the nature of what is required to utilize this dialysis modality (e.g., health literacy, caregiver support, proper home infrastructure).

Avalere used 100% Medicare fee-for-service (FFS) claims data, accessed via a research collaboration with Inovalon, Inc. and governed by a research-focused Centers for Medicare & Medicaid Services data use agreement. Avalere identified patients with end-stage renal disease who received renal replacement therapy (peritoneal dialysis and hemodialysis), excluding beneficiaries who received a kidney transplant between January 2019 and June 2022. Among these patients, Avalere stratified beneficiaries by Medicaid dual-eligibility status.

Key Findings

Between Q1 2019 and Q2 2022, the rate of home dialysis utilization grew from 12.3% to 15.9% across all Medicare FFS beneficiaries. In Q2 2022, 12.0% of the 113,226 dual-eligible beneficiaries utilized home dialysis compared to 19.7% of the 115,497 non-dual-eligible beneficiaries utilizing home dialysis (p<0.01).

This difference in utilization was consistent across the period of analysis. The rate of non-dual eligibles utilizing home dialysis was 7.7 percentage points higher than dual-eligible beneficiaries in Q1 2019 and 7.4 percentage points higher in Q1 2022.

Figure 1. Rates of Unique Medicare FFS Patients with a Home Dialysis Service in the Given Quarter
Figure 1. Rates of Unique Medicare FFS Patients with a Home Dialysis Service in the Given Quarter

Read the abstract for additional details on the methodology, results, and implications of these findings.

To learn more about the evolving kidney care market and opportunities to identify and address disparities in care, connect with us.

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