A novel US study has exposed the key drivers behind the functioning of kidney dialysis profit centers across the United States. Bottom line figures rule the roost, and these centers prescribe overdoses of anti-anemia drugs to realize higher hemoglobin levels in the patients.
The study which is published in the Journal of the American Medical Association, demonstrates how over dosing patients with anti-anemia drugs could endanger their lives. Abnormally high hemoglobin increases the risk of heart attacks, strokes and blood clots.
Healthy kidneys secrete a hormone called erythropoietin which is the catalyst behind the production of red blood cells in the bone marrow. Those patients suffering kidney disease do not produce adequate erythropoietin, therefore there is a dearth of red blood cells, causing anemia.
Epoetin is a drug that acts as a substitute for erythropoietin, and is being prescribed to kidney patients during the course of dialysis. The dosage is altered depending upon their hemoglobin levels and how anemic they are.
Hospitals as well as independently owned profit based units of dialysis across the United States are known to claim reimbursement from the government insurance scheme, Medicare, for the treatment meted out to the patient, which also includes the anti anemia drug epoetin.
According to this study conducted, Epoetin therapy accounted for 1.8 billion dollars of medical drug expenditure in 2004.
The records of 159,522 adult Medicare-eligible, end-stage renal disease patients from the US Renal Data System, undergoing hemodialysis at various centers during November and December 2004 was analyzed using statistical regression models to understand the average epoetin dose and dose adjustments executed by the profit centers. The findings revealed that dosing of the drug epoetin fluctuated according to the status of the dialysis centers, whether they were profit or non-profit centers.
It was also observed that the 106,116 patients who availed treatment from the large for-profit dialysis centers were regularly given the highest doses of epoetin as against 28,199 patients who undertook treatment from nonprofit centers, irrespective of their level of anemia.
It was also observed that a hospital-based centre administered an average dose of 16,188 units per week of epoetin, as against 'for-profit chain centers' that administered an average dose of 20,838 units a week.
The researchers inferred, "Dialysis facility organizational status and ownership are associated with variation in epoetin dosing in the United States. Different epoetin dosing patterns suggest that large for-profit chain facilities used larger dose adjustments and targeted higher hematocrit levels."
This trend has prompted the FDA to issue warnings for Epoetin against the indiscriminate use of this drug.