Roetker Nicholas S, Victores Alejandro, Kou Chuanyu, Bash Lori D, Ramey Dena Rosen, Boggs Robert L, Ke Xuehua, Bonaca Marc P, Wetmore James B
Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Merck & Co., Inc., Rahway, NJ, USA.
Kidney360. 2025 Jun 23. doi: 10.34067/KID.0000000867.
Major adverse thrombotic events (MATEs) are an important cause of morbidity and mortality in people with end-stage kidney disease (ESKD) receiving dialysis. Information on the extent to which the healthcare resource utilization (HCRU) and costs of treating MATEs differ between the dialysis and non-dialysis populations is limited.
Fee-for-service Medicare beneficiaries aged ≥66 years who experienced a first (index) MATE in 2015-2018 were studied using an observation cohort design. Individuals with ESKD receiving dialysis from the US Renal Data System were compared to individuals without ESKD from a 20% Medicare sample. MATEs were identified using claims-based algorithms. Outcomes included HCRU and Medicare payments during the index MATE and during a 1-year follow-up period. Costs of maintenance dialysis were excluded. Age-, sex-, and race-adjusted outcomes were estimated using model-based standardization. Separately for each MATE type, outcomes were compared for each of two ESKD cohorts (in-center hemodialysis [ICHD] and home dialysis) vs. a non-ESKD cohort.
Index MATE hospitalizations were roughly 1.2-1.3 times as long and 1.2-1.5 times as costly for patients with ESKD receiving ICHD (adjusted mean length of stay 7.0-10.3 days and cost $15.1K-$26.6K) than for patients without ESKD (5.6-7.6 days and $10.2K-$19.1K). Furthermore, in the 1-year follow-up, rates and per-person per-year costs of subsequent MATE-related hospitalizations were 2-3 times as high in patients receiving ICHD as in those without ESKD. HCRU and costs in patients receiving home dialysis were generally similar to, or higher than, in those receiving ICHD.
Among older adults with a MATE, those receiving dialysis had greater HCRU and costs compared to those without ESKD. Reducing HCRU and costs related to MATEs should be a focus of treatment for people receiving dialysis.
主要不良血栓事件（MATEs）是接受透析的终末期肾病（ESKD）患者发病和死亡的重要原因。关于透析人群和非透析人群中治疗MATEs的医疗资源利用（HCRU）程度及成本差异的信息有限。
采用观察队列设计研究了2015 - 2018年经历首次（索引）MATE的年龄≥66岁的按服务收费的医疗保险受益人。将美国肾脏数据系统中接受透析的ESKD患者与20%医疗保险样本中无ESKD的患者进行比较。使用基于索赔的算法识别MATEs。结局包括索引MATE期间及1年随访期内的HCRU和医疗保险支付。排除维持性透析成本。使用基于模型的标准化方法估计年龄、性别和种族调整后的结局。针对每种MATE类型，分别比较两个ESKD队列（中心血液透析[ICHD]和家庭透析）与非ESKD队列的结局。
接受ICHD的ESKD患者的索引MATE住院时间约为无ESKD患者的1.2 - 1.3倍，成本为1.2 - 1.5倍（调整后的平均住院时间为7.0 - 10.3天，成本为15100美元 - 26600美元），而无ESKD患者为5.6 - 7.6天和10200美元 - 19100美元。此外，在1年随访中，接受ICHD的患者后续MATE相关住院率和每人每年成本是无ESKD患者的2 - 3倍。接受家庭透析患者的HCRU和成本通常与接受ICHD的患者相似或更高。
在发生MATE的老年人中，接受透析的患者与无ESKD的患者相比，HCRU和成本更高。降低与MATEs相关的HCRU和成本应成为接受透析患者治疗的重点。
