April 22, 2003 - The ESRD Clinical Performance Measures (CPM) Project, now in its ninth 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 2002 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. New this year is the addition of findings for all in-center hemodialysis patients aged < 18.

The most recent data described in this report are from the 2002 study period which includes the months of October-December 2001 for the in-center hemodialysis patients and October 2001-March 2002 for the peritoneal dialysis patients. This report also compares the 2002 study period findings to findings from previous study periods AND it identifies opportunities to improve care for dialysis patients.

Reports Describing the 2002 CPM Data Collection Results - Annual Report:

• Report (PDF, 825 kb)
  
  
• References/Appendices (PDF, 181 kb)

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HIGHLIGHTS FROM THE NATIONAL FINDINGS FOR THE 2002 ESRD CPM DATA

IMPROVEMENT OCCURRED

• 89% of the sampled patients were receiving dialysis with a delivered calculated, single session Kt/V >= 1.2. This was an increase of three percentage points over late 2000
  
  
• 87% of Black patients and 89% of White patients were receiving dialysis with a mean delivered calculated, single session Kt/V >= 1.2 in October�December 2001. This was a three percentage point increase for Black patients and a two percentage point increase for White patients from late 2000.
  
  
• 76% of patients had a mean hemoglobin >= 11gm/dL in the last quarter of 2001 compared to 74% of the patients in the last quarter of 2000, a two percentage point increase from late 2000 to late 2001.
  
  
• 9% of Black patients and 7% of White patients had a mean hemoglobin < 10 gm/dL in October�December 2001 compared to 10% and 8%, respectively, in October�December 2000.

OPPORTUNITIES TO IMPROVE

• 11% of patients did not have a mean Kt/V >= 1.2 during the three-month study period.
  
  
• 71% of incident patients and 69% of all patients were not dialyzed with an AV fistula during their last hemodialysis session October-December 2001.
  
  
• 49% of patients with an AV graft did not have this graft routinely monitored for the presence of stenosis during the three month study period.
  
  
• 24% of patients did not have a mean hemoglobin >= 11gm/dL during the three month study period.
  
  
• 33% of patients prescribed Epoetin did not have a mean hemoglobin of 11�12.9 gm/dL during the three-month study period.
  
  
• 64% of patients did not have a mean serum albumin >= 4.0 gm/dL (BCG method) or >= 3.7 gm/dL (BCP method) during the three-month study period.

Adult In-Center Hemodialysis Patients

The data are from October-December 2001:

Hemodialysis Adequacy

• 82% of patients had monthly adequacy measurements performed (HD Adequacy CPM I)
  
  
• 68% of patients had their delivered Kt/V calculated using either UKM or the Daugirdas II formula (6) (HD Adequacy CPM II)
  
  
• 92% of patients on dialysis for 6 months or more and dialyzing three times a week had a mean delivered adequacy dose of Kt/V >= 1.2 calculated using the Daugirdas II formula (HD Adequacy CPM III)
  
  
• 89% of prevalent patients had a mean delivered calculated, single session adequacy dose of Kt/V >= 1.2
  
  
• Median Kt/V was 1.49
  
  
• 84% of patients had a mean URR >= 65%
  
  
• Median URR was 71.5%
  
  
• Median dialysis session length was 212 minutes

Vascular Access

• 29% of incident patients were dialyzed using an AV fistula (AVF) (Vascular Access CPM I)
  
  
• 31% of prevalent patients were dialyzed using an AVF (Vascular Access CPM I)
  
  
• 19% of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer (Vascular Access CPM II)
  
  
• 51% of prevalent patients with an AV graft were routinely monitored for the presence of stenosis (Vascular Access CPM III)

Anemia Management

• 38% of targeted patients prescribed Epoetin had a hemoglobin between 11.0-12.0 gm/dL (Anemia Management CPM I)
  
  
• 92% of patients who met the inclusion criteria1 had at least one documented transferrin saturation value and one documented serum ferritin concentration value (Anemia Management CPM IIa)
  
  
• 75% of patients who met the inclusion criteria1 had at least one transferrin saturation >= 20% and one serum ferritin concentration >= 100 ng/mL (Anemia Management CPM IIb)
  
  
• 77% of patients who met the inclusion criteria1 were prescribed intravenous iron in at least one month during the study period (Anemia Management CPM III)
  
  
• 76% of patients had a mean hemoglobin >= 11 gm/dL
  
  
• 8% of patients had a mean hemoglobin less than 10.0 gm/dL
  
  
• Median hemoglobin was 11.7 gm/dL
  
  
• Median weekly IV Epoetin dose was 199.1 units/kg/week
  
  
• Median weekly SC Epoetin dose was 167.2 units/kg/week

Serum Albumin

• 36% of patients had a mean serum albumin >= 4.0/3.7 gm/dL (BCG/BCP)
  
  
• 82% of patients had a mean serum albumin >= 3.5/3.2 gm/dL (BCG/BCP)
  
  
• Median serum albumin was 3.8/3.6 gm/dL (BCG/BCP)

Adult Peritoneal Dialysis Patients

The data are from October 2001-March 2002:

Peritoneal Dialysis 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
  
  
• 62% of patients had their total solute clearance for urea and creatinine calculated in a standard way1 (PD Adequacy CPM II)
  
  
• 68% 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)
  � 70% 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)
  
  
• 61% 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)
  
  
• Median weekly Kt/Vurea for CAPD patients was 2.27
  
  
• Median weekly Kt/Vurea for Cycler patients with a daytime dwell was 2.25
  
  
• Median weekly Kt/Vurea for Cycler patients without a daytime dwell was 2.29

Anemia Management

• 36% of targeted patients prescribed Epoetin had a mean hemoglobin between 11.0-12.0 gm/dL (Anemia Management CPM I)
  
  
• 74% of patients who met the inclusion criteria2 had at least two documented transferrin saturation values and two documented serum ferritin concentration values during the six month study period (Anemia Management CPM IIa)
  
  
• 76% of patients who met the inclusion criteria2 had at least one transferrin saturation � 20% and one serum ferritin concentration >= 100 ng/mL (Anemia Management CPM IIb)
  
  
• 31% of patients who met the inclusion criteria2 were prescribed intravenous iron in at least one of the two-month periods during the study period (Anemia Management CPM III)
  
  
• 76% of patients had a mean hemoglobin >= 11 gm/dL
  
  
• Median hemoglobin was 11.8 gm/dL
  
  
• Median weekly SC Epoetin dose was 119.1 units/kg/week
  
  
• Median weekly IV Epoetin dose was 146.9 units/kg/week

Serum Albumin

• 19% of patients had a mean serum albumin >= 4.0/3.7 gm/dL (BCG/BCP)
  
  
• 61% of patients had a mean serum albumin >= 3.5/3.2 gm/dL (BCG/BCP)
  
  
• Median serum albumin was 3.6/3.3 gm/dL (BCG/BCP)

Pediatric In-Center Hemodialysis Patients (aged < 18)

The data are from October-December 2001:

Hemodialysis Adequacy

• 87% of patients had a mean delivered calculated, single session adequacy dose of Kt/V >= 1.2 calculated using the Daugirdas II forumula
  
  
• Median Kt/V was 1.54
  
  
• Median dialysis session length was 201 minutes

Vascular Access

• 26% of prevalent patients were dialyzed using an AV fistula (AVF)
  
  
• 46% of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer
  
  
• 48% of prevalent patients with an AVF or an AV graft were routinely monitored for the presence of stenosis

Anemia Management

• 62% of patients had a mean hemoglobin >= 11 gm/dL
  
  
• Median hemoglobin was 11.4 gm/dL
  
  
• Median weekly IV Epoetin dose was 278.9 units/kg/week

Serum Albumin

• 41% of patients had a mean serum albumin � 4.0/3.7 gm/dL (BCG/BCP)
  
  
• 82% of patients had a mean serum albumin >= 3.5/3.2 gm/dL (BCG/BCP)

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[This message has been edited by Gary Peterson (edited 06-30-2003).]