Ensuring the Equitable Advancement of American Kidney Health—the Need to Account for Socioeconomic Disparities in the ESRD Treatment Choices Model

Treatment Patterns and Characteristics of Dialysis Facilities Randomly Assigned to the Medicare End-Stage Renal Disease Treatment Choices Model

“…Under the ETC model’s risk adjustment protocol, CMS will age-adjust transplantation rates and stratify facilities by the proportion of patients dually enrolled in Medicare and Medicaid or who receive Medicare’s low-income subsidy. 3 , 25 This protocol may account for some of the average differences between ETC-assigned and control facilities that we observed in patient-, facility-, and community-level characteristics. Future studies of facility-level associations between social risk factors and low transplant and home dialysis use among ETC-assigned facilities could inform further revisions to CMS’s protocol as needed.…”

“… 24 From USRDS data we derived facility-level average patient characteristics used in the ETC model’s risk adjustment and stratification protocols: mean age (transplant rates are age-adjusted) and percentage with Medicaid insurance (ie, dually Medicare- and Medicaid-enrolled). 3 , 25 Other aggregated patient characteristics included percentages female; percentages Hispanic, non-Hispanic Asian American, non-Hispanic Black or African American, non-Hispanic White, and other race/ethnicity (American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and other [unspecified]); percentage with a body of mass index (calculated as weight in kilograms divided by height in meters squared) greater than 35; and percentage having received pre–kidney failure nephrology care. We define race as a social construct, not a biological one, 26 and interpret race and receipt of pre–kidney failure nephrology care as proxies for unmeasured social risk factors, including those associated with access to care (eg, poverty, social position).…”

Design and proof-of-concept evaluation of a touchless connector system for preventing peritoneal dialysis-associated peritonitis

“…There is renewed interest in PD in both high-income and low-income and middle-income countries. In the USA for example, a new payment model introduced by the Centers for Medicare and Medicaid Services is incentivising physicians and providers to increase the proportion of patients on home therapies like PD 1. The COVID-19 pandemic and the desire for social distancing also increased PD demand 2…”

Formative usability assessment of a new connector design for peritoneal dialysis

“…The International Society of Nephrology has recommended a Peritoneal Dialysis first approach as a strategy for dealing with the limited access to renal replacement therapy in low and middle income countries where up to 7 million deaths may be occurring due to poor access to therapy [1,2]. In the United States, a new government initiative, Advancing American Kidney Health Initiative, has set a goal to increase the proportion of kidney failure patients on home treatments like peritoneal dialysis from current ~10% to about 80% by 2025, with new changes in payment models to support this [3]. However, a major drawback of peritoneal dialysis is peritonitis, an infection of the peritoneal membrane through which the therapy occurs.…”