May 27, 2005 - The ESRD Clinical Performance Measures (CPM) Project, now in its eleventh year, is a national effort led by the Centers for Medicare & Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), and its eighteen ESRD Networks to assist dialysis providers to improve patient care and outcomes. Since 1994 the Project has documented continued improvements, specifically in the areas of adequacy of dialysis and anemia management. The providers of dialysis services are to be commended for their ongoing efforts to improve patient care.

The 2004 ESRD CPM Annual Report describes the findings of several important clinical measures and/or characteristics of a nationally representative random sample of adult (aged >=18 years) in-center hemodialysis patients and peritoneal dialysis patients. Included again this year are the findings for all in-center hemodialysis patients aged < 18.

The most recent data described in this Report are from the 2004 study period which includes the months of October-December 2003 for the in-center hemodialysis patients and October 2003- March 2004 for the peritoneal dialysis patients. This Report also compares the 2004 study period findings to findings from previous study periods AND it identifies opportunities to improve care for dialysis patients.

The full 2004 100-Page Report (pdf) can be found on the Internet at this CMS web page, www.cms.hhs.gov/esrd/1.asp, along with previous years reports.

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HIGHLIGHTS FROM THE NATIONAL FINDINGS FOR THE 2004 ESRD CPM DATA

Random Sample Adult In-Center Hemodialysis (HD) Patients (n=8,634)

The data are from OCT-DEC 2003:

HD Adequacy

• 83% of patients had monthly adequacy measurements performed (HD Adequacy CPM I)
  
• 83% of patients had their delivered spKt/V calculated using either UKM or the Daugirdas II formula (26) (HD Adequacy CPM II)
  
• 94% of patients on dialysis for 6 months or more and dialyzing three times a week had a mean delivered adequacy dose of spKt/V � 1.2 calculated using the Daugirdas II formula (HD Adequacy CPM III)
  

Vascular Access (VA)

• 35% of incident patients were dialyzed using an AV fistula (AVF) (VA CPM I)
  
• 35% of prevalent patients were dialyzed using an AVF (VA CPM I)
  
• 20% of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer (VA CPM II)
  
• 77% of prevalent patients with an AV graft were routinely monitored for the presence of stenosis (VA CPM III)
  

Anemia Management (AM)

• 36% of targeted patients prescribed Epoetin had a mean hemoglobin 11.0-12.0 g/dL (110-120 g/L) (AM CPM I)
  
• 96% of patients who met the inclusion criteria1 had at least one documented transferrin saturation value and one documented serum ferritin concentration value during the study period (AM CPM IIa)
  
• 81% of patients who met the inclusion criteria1 had at least one transferrin saturation >= 20% and one serum ferritin concentration >= 100 ng/mL during the study period (AM CPM IIb)
  
• 79% of patients who met the inclusion criteria1 were prescribed intravenous iron in at least one month during the study period (AM CPM III)
  

Random Sample of Adult Peritoneal Dialysis (PD) Patients (n=1377)

The data are from OCT 2003�MAR 2004:

PD Adequacy

• 86% of patients had at least one measured total solute clearance for urea and creatinine (PD Adequacy CPM I) during the six-month study period
  
• 44% of patients had their total solute clearance for urea and creatinine calculated in a standard way (PD Adequacy CPM II)
  
• 70% of CAPD patients had a mean weekly Kt/Vurea of >=2.0 and a mean weekly creatinine clearance >= 60L/week/1.73m2 OR there was evidence the dialysis prescription was changed if the adequacy measurements were below these thresholds during the six-month study period (PD Adequacy CPM III)
  
• 65% of Cycler patients with a daytime dwell had a mean weekly Kt/Vurea of >= 2.1 and a mean weekly creatinine clearance >= 63 L/week/1.73m2 OR there was evidence the dialysis prescription was changed if the adequacy measurements were below these thresholds during the six-month study period (PD Adequacy CPM III)
  
• 62% of Cycler patients without a daytime dwell had a mean Kt/Vurea of >= 2.2 and a mean weekly creatinine clearance >= 66 L/week/1.73m2 OR there was evidence the dialysis prescription was changed if the adequacy measurements were below these thresholds during the six-month study period (PD Adequacy CPM III)
  

Anemia Management (AM)

• 39% of targeted patients prescribed Epoetin had a mean hemoglobin between 11.0-12.0 g/dL (110-120 g/L) (AM CPM I)
  
• 79% of patients who met the inclusion criteria for this CPM had at least two documented transferrin saturation values and two documented serum ferritin concentration values during the six-month study period (AM CPM IIa)
  
• 83% of patients who met the inclusion criteria for this CPM had at least one transferrin saturation >= 20% and one serum ferritin concentration >= 100 ng/mL during the six-month study period (AM CPM IIb)
  
• 29% of patients who met the inclusion criteria for this CPM were prescribed intravenous iron in at least one of the two-month periods during the six-month study period (AM CPM III)
  

SIGNIFICANT FINDINGS FROM THE NATIONAL 2004 ESRD CPM PROJECT

Random Sample of Adult In-Center Hemodialysis (HD) Patients (n=8,634 sample for analysis). The data are from OCT-DEC 2003:

HD Adequacy

• 91% of prevalent patients had a mean
  delivered calculated, single session adequacy dose of spKt/V � 1.2
  
• 94% of female patients and 88% of male patients were receiving dialysis with a mean delivered calculated, single session spKt/V � 1.2 in OCT-DEC 2003
  
• Mean (� SD) spKt/V was 1.53 (� 0.26)
  
• 87% of patients had a mean URR � 65%
  
• Mean (� SD) URR was 72.0 (� 6.8)%
  
• Mean SD) dialysis session length was 216 (� 30) minutes
  

Opportunity to Improve Adequacy

• 9% of patients did not have a mean spKt/V >=1.2 during the three-month study period
  

Vascular Access

• 35% of incident and 35% of prevalent patients were dialyzed with an AVF during their last hemodialysis session OCT-DEC 2003
  
• 75% of patients with an AVF or AV graft had their access routinely monitored for the presence of stenosis during the three-month study period
  

Opportunities to Improve Vascular Access

• 65% of incident patients and 65% of all patients were not dialyzed with an AVF during their last hemodialysis session OCT-DEC 2003
  
• 23% of patients with an AV graft did not have this graft routinely monitored for the presence of stenosis during the three-month study period
  

Anemia Management

• 80% of patients had a mean hemoglobin >= 11 g/dL (110 g/L) in the last quarter of 2003
  
• 6% of patients had a mean hemoglobin less than 10.0 g/dL (100 g/L)
  
• Mean (� SD) hemoglobin was 11.9 (� 1.2) g/dL
  (119 [� 12] g/L)
  
• Mean (� SD) weekly IV and SC Epoetin dose was 271.3 (� 251.8) units/kg/week and 206.2(� 184.8) units/kg/week respectively
  
• 81% of patients had a mean transferrin saturation >= 20%
  
• 94% of patients had a mean serum ferritin concentration >= 100 ng/mL
  
• 25% of patients had a mean serum ferritin > 800 ng/mL
  
• 65% of patients were prescribed IV iron during the study period
  
• Mean (� SD) IV iron dose was 233.4 (� 194.4) mg/month
  

Opportunities to Improve Anemia Management

• 20% of patients did not have a mean
  hemoglobin >=11 g/dL (110 g/L) during the three-month study period
  
• 19% of patients did not have a mean transferrin saturation >= 20% and 6% of patients did not have a mean serum ferritin >= 100 ng/mL
  
• 35% of patients were not prescribed IV iron during the study period
  

Serum Albumin

• 39% of patients had a mean serum albumin >= 4.0/3.7 g/dL (40/37 g/L) (BCG/BCP)1
  
• 81% of patients had a mean serum albumin >= 3.5/3.2 g/dL (35/32 g/L) (BCG/BCP)
  
• Mean (� SD) serum albumin was 3.8 (� 0.4)/3.5 (� 0.5) g/dL (38[�4]/35[�5] g/L) (BCG/BCP)
  

Opportunity to Improve Serum Albumin

• 61% of patients did not have a mean serum albumin >= 4.0/3.7g/dL (40/37 g/L) (BCG/BCP)