ESRD Care Within the US Department of Veterans Affairs: A Forward-Looking Program With an Illuminating Past

Watnick, Suzanne; Crowley, Susan T.

doi:10.1053/j.ajkd.2013.10.046

Cited by 15 publications

(17 citation statements)

References 22 publications

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“…To that end, a VA dialysis center is unique, as compared to other non-VA dialysis clinics where, until December 2016, inpatient dialysis treatments might not be performed according to the regulations governed by the Center for Medicare and Medicaid Services (CMS). 13 …”

Section: Veterans With Advanced Ckd and Esrdmentioning

confidence: 99%

“…Dialysis care is a covered benefit under VA’s Medical Benefits Package for Veterans enrolled in the VA, irrespective of their service connectedness. 13 For patients requiring in-center dialysis treatment, the VHA provides dialysis both through units maintained and operated by individual VA facilities (hence usually hospital based dialysis centers), or by outsourcing dialysis services to private dialysis providers. This may happen in cases where the distance from a VA facility is prohibitive for thrice-weekly dialysis therapy, when there is a lack of home dialysis resources or expertise, or when the capacity of the VA facility-operated dialysis unit is exceeded.…”

Section: Veterans With Advanced Ckd and Esrdmentioning

confidence: 99%

“…This may happen in cases where the distance from a VA facility is prohibitive for thrice-weekly dialysis therapy, when there is a lack of home dialysis resources or expertise, or when the capacity of the VA facility-operated dialysis unit is exceeded. 13 …”

Section: Veterans With Advanced Ckd and Esrdmentioning

confidence: 99%

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Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease

Kalantar-Zadeh

Crowley

Beddhu

et al. 2017

Seminars in Dialysis

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Each year approximately 13,000 Veterans transition to maintenance dialysis, mostly in the traditional form of thrice-weekly hemodialysis from the start. Among >6,000 dialysis units nationwide, there are currently approximately 70 Veterans Affairs (VA) dialysis centers. Given this number of VA dialysis centers and their limited capacity, only 10% of all incident dialysis Veterans initiate treatment in a VA center. Evidence suggests that, among Veterans, receipt of care within the VA system is associated with favorable outcomes, potentially due to enhanced access to healthcare resources. Data from the United States Renal Data System Special Study Center “Transition-of-Care-in-CKD” suggest that Veterans who receive dialysis in a VA unit exhibit greater survival compared to non-VA centers. Substantial financial expenditures arise from the high volume of outsourced care and higher dialysis reimbursement paid by the VA than by Medicare to outsourced providers. Given the exceedingly high mortality and abrupt decline in residual kidney function (RKF) in the first dialysis year, it is possible that incremental transition to dialysis through an initial twice-weekly hemodialysis regimen preserves RKF, prolongs vascular access longevity, improves patients’ quality of life, and is a more patient-centered approach and consistent with “personalized” dialysis. Broad implementation of incremental dialysis may also result in more Veterans receiving care within a VA dialysis unit. Controlled trials are urgently needed to examine safety and efficacy of incremental hemodialysis in Veterans and other populations, and the administrative and health care as well as provider structure within the VA system would facilitate the performance of such trials.

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Section: Veterans With Advanced Ckd and Esrdmentioning

confidence: 99%

Section: Veterans With Advanced Ckd and Esrdmentioning

confidence: 99%

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Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease

Kalantar-Zadeh

Crowley

Beddhu

et al. 2017

Seminars in Dialysis

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“…In our analysis, we excluded individuals with any previous kidney transplant but we did not have information on persons listed in CY 2013 for kidney transplantation. However, only 3% of dialysis dependent Veterans were listed for kidney transplantation in CY 2011 …”

Section: Discussionmentioning

confidence: 99%

Statin use among Veterans with dialysis‐dependent chronic kidney disease

Markossian

Kramer

Burge

et al. 2019

Hemodialysis International

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Introduction: The benefits of statin medications in patients receiving maintenance dialysis remains controversial and clinical trials overall have shown no benefit. Potential side effects of statin medications include myalgias, myopathy, and memory loss and risk of side effects associated with statin medications increase with higher statin doses. We examined statin use and statin dose among Veterans with dialysis dependent CKD. Such information may help clinicians modulate medication use and reduce pill burden in appropriate patients. Methods: This cross‐sectional analysis ascertained medication utilization by linking records from the U.S. Department of Veteran's Affairs (VA) Managerial Cost Accounting Pharmacy National Data Extracts and Medicare Part D during calendar year 2013 for Veterans with dialysis‐dependent CKD enrolled in and/or using VA healthcare. The venue of dialysis and patient characteristics were ascertained by linking VA Medical SAS datasets, VA Fee Basis datasets (for non‐VA care paid for by VA), Medicare claims and the United States Renal Data Systems patient core files. Findings: We identified 18,494 Veterans with dialysis‐dependent CKD who were enrolled in and/or used VA healthcare, had no history of kidney transplantation, and were alive on January 1, 2014. More than half (58.1%) of Veterans with dialysis‐dependent CKD used statins and 35.7% of statin utilization was high dose. Statins were the third most commonly prescribed medication after beta blockers (64.8%) and phosphate binders (64.5%). Discussion: Statins are a commonly prescribed medication among Veterans receiving maintenance dialysis and approximately one‐third of statin utilization is high dose in this population. Future studies should examine patient preferences, comorbidities, and dialysis characteristics that impact the risks and benefits of statin use in order to identify those patients who will or will not benefit from continued statin use.

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“…The VA has a legacy of innovation in the care of people with kidney failure (4). Half a century ago, the VA established the first national dialysis program for people with ESRD, and its physicians developed the arteriovenous fistula.…”

Section: Introductionmentioning

confidence: 99%