Volume 2: End-Stage Renal Disease

Volume 2: End-Stage Renal Disease
2018 Annual Data Report Volume 2: End-Stage Renal Disease

2018 Annual Data Report Volume 2 ESRD, Chapter 2
vol 2 Figure 2.1 ESRD clinical indicator levels among prevalent hemodialysis versus peritoneal dialysis patients in CROWNWeb data, May 2017: (a) percentage of patients meeting clinical care guidelines for dialysis adequacy; (b) percent distribution of Hgb levels; (c) percentage of patients with serum calcium >10.2 mg/dL; (d) percent distribution of serum albumin levels. (a) Percentage of prevalent hemodialysis and peritoneal dialysis patients meeting clinical care guidelines for dialysis adequacy, by modality Data Source: Special analyses, USRDS ESRD Database. Results shown are for laboratory values reported to CROWNWeb for May 2017, restricted to patients as follows: (a) dialysis patients initiating treatment for ESRD at least 1 year prior to May 1, 2017, and who were alive through May 31, 2017; (b) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; (c) hemodialysis and peritoneal dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; and (d) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; HD, hemodialysis; Hgb, hemoglobin; Kt/V, see Glossary; PD, peritoneal dialysis. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.1 ESRD clinical indicator levels among prevalent hemodialysis versus peritoneal dialysis patients in CROWNWeb data, May 2017: (a) percentage of patients meeting clinical care guidelines for dialysis adequacy; (b) percent distribution of Hgb levels; (c) percentage of patients with serum calcium >10.2 mg/dL; (d) percent distribution of serum albumin levels. (b) Percent distribution of Hgb levels among prevalent hemodialysis and peritoneal dialysis patients Data Source: Special analyses, USRDS ESRD Database. Results shown are for laboratory values reported to CROWNWeb for May 2017, restricted to patients as follows: (a) dialysis patients initiating treatment for ESRD at least 1 year prior to May 1, 2017, and who were alive through May 31, 2017; (b) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; (c) hemodialysis and peritoneal dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; and (d) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; HD, hemodialysis; Hgb, hemoglobin; Kt/V, see Glossary; PD, peritoneal dialysis. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.1 ESRD clinical indicator levels among prevalent hemodialysis versus peritoneal dialysis patients in CROWNWeb data, May 2017: (a) percentage of patients meeting clinical care guidelines for dialysis adequacy; (b) percent distribution of Hgb levels; (c) percentage of patients with serum calcium >10.2 mg/dL; (d) percent distribution of serum albumin levels (continued) (c) Percentage of dialysis patients with serum calcium >10.2 mg/dL, by modality Data Source: Special analyses, USRDS ESRD Database. Results shown are for laboratory values reported to CROWNWeb for May 2017, restricted to patients as follows: (a) dialysis patients initiating treatment for ESRD at least 1 year prior to May 1, 2017, and who were alive through May 31, 2017; (b) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; (c) hemodialysis and peritoneal dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; and (d) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; HD, hemodialysis; Hgb, hemoglobin; Kt/V, see Glossary; PD, peritoneal dialysis. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.1 ESRD clinical indicator levels among prevalent hemodialysis versus peritoneal dialysis patients in CROWNWeb data, May 2016: (a) percentage of patients meeting clinical care guidelines for dialysis adequacy; (b) percent distribution of Hgb levels; (c) percentage of patients with serum calcium >10.2 mg/dL; (d) percent distribution of serum albumin levels (continued) (d) Percent distribution of serum albumin levels among prevalent hemodialysis and peritoneal dialysis patients Data Source: Special analyses, USRDS ESRD Database. Results shown are for laboratory values reported to CROWNWeb for May 2017, restricted to patients as follows: (a) dialysis patients initiating treatment for ESRD at least 1 year prior to May 1, 2017, and who were alive through May 31, 2017; (b) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; (c) hemodialysis and peritoneal dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, 2017; and (d) dialysis patients initiating treatment for ESRD at least 90 days prior to May 1, 2017, who were ≥18 years old as of May 1, 2017, and who were alive through May 31, Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; HD, hemodialysis; Hgb, hemoglobin; Kt/V, see Glossary; PD, peritoneal dialysis. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.2 Anemia measures among adult hemodialysis patients on dialysis ≥90 days: (a) mean monthly Hgb level and mean weekly EPO alfa dose (averaged over a month), (b) mean monthly Hgb level and mean monthly darbepoetin dose, (c) mean monthly Hgb level and mean monthly PEG-EPO beta dose, and (d) percent ESA use monthly, Medicare claims, Data Source: Special analyses, USRDS ESRD Database. Mean monthly Hgb level among (a )EPO alfa (b) darbepoetin (c) PEG-EPO beta patients on dialysis ≥ 90 days ( ) or (a) mean monthly Hgb level among all adult hemodialysis patients (April 2012 to December 2016 only) who, within the given month had a Hgb claim (only 1st reported Hgb values in a month were used) and were on dialysis ≥ 90 days; analyses were restricted to patients ≥ 18 years old and who had been on dialysis ≥ 90 days at the start of the month. Average weekly (EPO alfa, Figure 2.2.a) or monthly (darbepoetin and PEG-EPO beta, Figures 2.2.b and c) doses are shown for hemodialysis patients who within a given month had a corresponding ESA claim. EPO alfa dose is expressed as mean EPO alfa units per week averaged over all of a patient’s EPO alfa claims within a given month. Darbepoetin and PEG-EPO beta dose are expressed as mean units per month over all of a patient’s corresponding darbepoetin or PEG-EPO beta claims within a given month; (d) Monthly ESA use in all hemodialysis patients who were ≥ 18 years and on dialysis ≥ 90 days. Abbreviations: EPO alfa, erythropoietin alfa; ESRD, end-stage renal disease; PEG-EPO beta, pegylated erythropoetin beta; ESA, erythropoiesis-stimulating agents; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.2 Anemia measures among adult hemodialysis patients on dialysis ≥90 days: (a) mean monthly Hgb level and mean weekly EPO alfa dose (averaged over a month), (b) mean monthly Hgb level and mean monthly darbepoetin dose, (c) mean monthly Hgb level and mean monthly PEG-EPO beta dose, and (d) percent ESA use monthly, Medicare claims, (continued) Data Source: Special analyses, USRDS ESRD Database. Mean monthly Hgb level among (a )EPO alfa (b) darbepoetin (c) PEG-EPO beta patients on dialysis ≥ 90 days ( ) or (a) mean monthly Hgb level among all adult hemodialysis patients (April 2012 to December 2016 only) who, within the given month had a Hgb claim (only 1st reported Hgb values in a month were used) and were on dialysis ≥ 90 days; analyses were restricted to patients ≥ 18 years old and who had been on dialysis ≥ 90 days at the start of the month. Average weekly (EPO alfa, Figure 2.2.a) or monthly (darbepoetin and PEG-EPO beta, Figures 2.2.b and c) doses are shown for hemodialysis patients who within a given month had a corresponding ESA claim. EPO alfa dose is expressed as mean EPO alfa units per week averaged over all of a patient’s EPO alfa claims within a given month. Darbepoetin and PEG-EPO beta dose are expressed as mean units per month over all of a patient’s corresponding darbepoetin or PEG-EPO beta claims within a given month; (d) Monthly ESA use in all hemodialysis patients who were ≥ 18 years and on dialysis ≥ 90 days. Abbreviations: EPO alfa, erythropoietin alfa; ESRD, end-stage renal disease; PEG-EPO beta, pegylated erythropoetin beta; ESA, erythropoiesis-stimulating agents; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.3 Distribution of monthly Hgb levels in ESA-treated adult hemodialysis patients on dialysis ≥90 days, Medicare claims, Data Source: Special analyses, USRDS ESRD Database. Distribution of monthly Hgb levels among hemodialysis patients within a given month who had claims for Hgb level and ESA use, were on dialysis ≥90 days and ≥18 years old at the start of the month. Abbreviations: ESRD, end-stage renal disease; ESA, erythropoiesis-stimulating agents; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.4 Monthly percent IV iron use and mean monthly IV iron dose in adult hemodialysis patients on dialysis ≥90 days, Medicare claims, Data Source: Special analyses, USRDS ESRD Database. Monthly IV iron use is among hemodialysis patients on dialysis ≥90 days and ≥18 years old at the start of the given month. Mean IV iron dose was calculated as the average number of mg of IV iron given to all such patients during a month, among patients receiving iron during the month. Abbreviations: ESRD, end-stage renal disease; IV, intravenous. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.5 Distribution of TSAT levels in adult hemodialysis patients on dialysis for at least 90 days, CROWNWeb data, May 2015, 2016, and 2017 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March to May for years 2015, 2016, and Dialysis patients on treatment for ESRD at least 90 days before the time of measurement of TSAT level for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; TSAT, transferrin saturation. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Table 2.1 TSAT by age, sex, race, and primary ESRD cause in hemodialysis patients, May 2017 N TSAT <20% TSAT 20-<30% TSAT 30-<40% TSAT≥40% Overall 441,443 15.9% 34.8% 26.4% 22.8% Age 0-21 1,043 21.5 25.2 23.3 30.0 22-44 50,498 16.8 34.5 25.4 23.4 45-64 183,368 16.1 35.2 26.2 22.4 65-74 114,918 15.5 34.6 27.1 22.8 75+ 91,616 15.3 34.7 26.7 Sex Male 252,263 15.8 22.5 Female 189,163 16.0 35.1 25.6 Race White 250,955 16.3 34.4 26.4 Black/African American 159,310 35.7 26.6 American Indian or Alaska Native 5,379 15.7 33.5 26.0 24.9 Asian 17,991 14.6 25.8 Primary cause of ESRD Diabetes 206,682 15.9 35.5 26.5 22.0 Hypertension 130,743 Glomerulonephritis 45,037 33.9 26.3 23.8 Cystic Kidney 11,161 17.3 26.9 20.1 Other/Unknown 45,199 33.3 25.7 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March through May of Dialysis patients on treatment for ESRD at least 90 days before the time of measurement of TSAT level for that year, >=18 years old as of May 1, 2017 and who were alive through May 31, Table includes row percentages within demographic categories from May Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; TSAT, transferrin saturation. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.6 Distribution of the most recent value of serum ferritin level taken between March and May in adult hemodialysis patients on dialysis for at least 90 days, CROWNWeb data, Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March to May for years 2015, 2016, and Dialysis patients initiating treatment for ESRD at least 90 days before the time of measurement of serum ferritin for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Figure includes row percentages within demographic categories from May Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Table 2.2 Serum ferritin by age, sex, race, and primary ESRD cause in hemodialysis patients, May 2017 N Ferritin <200 ng/mL Ferritin ng/mL Ferritin ng/mL Ferritin ng/mL Ferritin >1200 ng/mL Overall 436,264 5.0% 15.3% 23.8% 30.4% 25.5% Age 0-21 1,033 9.2 29.3 24.3 22.5 14.7 22-44 49,927 6.8 18.9 24.7 28.0 21.5 45-64 181,274 5.7 16.3 24.2 29.8 65-74 113,489 4.3 14.3 23.4 31.2 26.7 75+ 90,541 3.3 12.7 22.9 31.9 29.2 Sex Male 249,218 5.9 16.9 24.6 29.6 23.0 Female 187,029 3.8 13.3 22.7 31.4 28.9 Race White 247,758 5.3 30.3 23.5 Black/African American 157,733 4.6 14.0 22.3 30.2 American Indian or Alaska Native 5,363 17.5 25.8 21.2 Asian 17,813 3.6 13.4 25.3 31.8 25.9 Primary cause of ESRD Diabetes 203,988 4.4 15.6 24.5 30.8 Hypertension 129,318 4.7 23.1 30.5 27.0 Glomerulonephritis 44,653 14.9 26.5 Cystic Kidney 11,092 12.5 18.4 22.0 27.5 19.6 Other/Unknown 44,641 23.7 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March to May Dialysis patients initiating treatment for ESRD at least 90 days before the time of measurement of serum ferritin for that year, ≥18 years old as of May 1, 2017, and who were alive through May 31, Table includes row percentages within demographic categories from May Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.7 Percentage of all adult hemodialysis patients (a) by number of red blood cell transfusions received in a year, and (b) with ≥1 claim for a red blood cell transfusion in a month, from Medicare claims data overall, within 90 days and after at least 90 days of first HD session, Data Source: Special analyses, USRDS ESRD Database. (a) The percent of hemodialysis patients ≥18 years with total number of red blood cell transfusion claims in a given year among dialysis patients having a claim for at least one hemodialysis session during the year. (b) The percentage of hemodialysis patients ≥18 years old at the start of the month with ≥1 red blood cell transfusion claims in a given month among hemodialysis patients having a claim for at least one dialysis session during the month. Additional analysis of RBC transfusion claims completed for patients on dialysis for < 90 days or ≥ 90 days. Abbreviations: ESRD, end-stage renal disease; RBC, red blood cell; Pts, patients. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.7 Percentage of all adult hemodialysis patients (a) by number of red blood cell transfusions received in a year, and (b) with ≥1 claim for a red blood cell transfusion in a month, from Medicare claims data overall, within 90 days and after at least 90 days of first HD session, (b) Percent of all patients on dialysis <90 days, or patients on dialysis ≥ 90 days, who had ≥1 claim for a red blood cell transfusion in a month Data Source: Special analyses, USRDS ESRD Database. (a) The percent of hemodialysis patients ≥18 years with total number of red blood cell transfusion claims in a given year among dialysis patients having a claim for at least one hemodialysis session during the year. (b) The percentage of hemodialysis patients ≥18 years old at the start of the month with ≥1 red blood cell transfusion claims in a given month among hemodialysis patients having a claim for at least one dialysis session during the month. Additional analysis of RBC transfusion claims completed for patients on dialysis for < 90 days or ≥ 90 days. Abbreviations: ESRD, end-stage renal disease; RBC, red blood cell; Pts, patients. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.8 Anemia measures among adult peritoneal dialysis patients on dialysis ≥90 days: (a) mean monthly Hgb level and mean weekly EPO alfa dose (averaged over a month), (b) mean monthly Hgb and mean monthly darbepoetin dose, and (c) percent ESA use monthly, Medicare claims, (a) Mean monthly Hgb level and mean weekly epoetin alfa dose Data Source: Special analyses, USRDS ESRD Database. Mean monthly Hgb level among (a) EPO alfa-, (b) darbepoetin, (c)PEG-EPO beta on dialysis ≥ 90 days ( ) or (a) mean monthly Hgb level among all adult peritoneal dialysis patients (April 2012 to December 2016 only) who, within the given month, had a Hgb claim (only 1st reported Hgb value in a month were used) and were on dialysis ≥ 90 days; analyses were restricted to patients ≥ 18 years old and who had been on dialysis ≥ 90 days at the start of the month. Average weekly (EPO alfa, Figure 2.8.a) or monthly (darbepoetin, Figure 2.8.b & PEG-EPO beta, Figure 2.8.C) doses are shown for peritoneal dialysis patients who within a given month had a corresponding ESA claim. EPO alfa dose is expressed as mean EPO alfa units per week averaged over all a patient’s EPO alfa claims within a given month. Darbepoetin and PEG-EPO beta doses are expressed as mean units per month over all of a patient’s corresponding Darbepoetin or PEG-EPO beta claims within a given month; (d) Monthly ESA use (EPO alfa, Darbepoetin, or PEG-EPO beta) in all peritoneal dialysis patients who were ≥ 18 years and on dialysis ≥ 90 days. Abbreviations: EPO alfa, erythropoietin alfa; ESRD, end-stage renal disease; PEG-EPO beta, pegylated erythropoetin beta; ESA, erythropoiesis-stimulating agents; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.8 Anemia measures among adult peritoneal dialysis patients on dialysis ≥90 days: (a) mean monthly Hgb level and mean weekly EPO alfa dose (averaged over a month), (b) mean monthly Hgb and mean monthly darbepoetin dose, and (c) percent ESA use monthly, Medicare claims, (b) Mean monthly Hgb level and mean monthly darbepoetin dose Data Source: Special analyses, USRDS ESRD Database. Mean monthly Hgb level among (a) EPO alfa-, (b) darbepoetin, (c)PEG-EPO beta on dialysis ≥ 90 days ( ) or (a) mean monthly Hgb level among all adult peritoneal dialysis patients (April 2012 to December 2016 only) who, within the given month, had a Hgb claim (only 1st reported Hgb value in a month were used) and were on dialysis ≥ 90 days; analyses were restricted to patients ≥ 18 years old and who had been on dialysis ≥ 90 days at the start of the month. Average weekly (EPO alfa, Figure 2.8.a) or monthly (darbepoetin, Figure 2.8.b & PEG-EPO beta, Figure 2.8.C) doses are shown for peritoneal dialysis patients who within a given month had a corresponding ESA claim. EPO alfa dose is expressed as mean EPO alfa units per week averaged over all a patient’s EPO alfa claims within a given month. Darbepoetin and PEG-EPO beta doses are expressed as mean units per month over all of a patient’s corresponding Darbepoetin or PEG-EPO beta claims within a given month; (d) Monthly ESA use (EPO alfa, Darbepoetin, or PEG-EPO beta) in all peritoneal dialysis patients who were ≥ 18 years and on dialysis ≥ 90 days. Abbreviations: EPO alfa, erythropoietin alfa; ESRD, end-stage renal disease; PEG-EPO beta, pegylated erythropoetin beta; ESA, erythropoiesis-stimulating agents; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.8 Anemia measures among adult peritoneal dialysis patients on dialysis ≥90 days: (a) mean monthly Hgb level and mean weekly EPO alfa dose (averaged over a month), (b) mean monthly Hgb and mean monthly darbepoetin dose, and (c) percent ESA use monthly, Medicare claims, (c) Mean monthly Hgb level and mean monthly PEG-EPO beta dose Data Source: Special analyses, USRDS ESRD Database. Mean monthly Hgb level among (a) EPO alfa-, (b) darbepoetin, (c)PEG-EPO beta on dialysis ≥ 90 days ( ) or (a) mean monthly Hgb level among all adult peritoneal dialysis patients (April 2012 to December 2016 only) who, within the given month, had a Hgb claim (only 1st reported Hgb value in a month were used) and were on dialysis ≥ 90 days; analyses were restricted to patients ≥ 18 years old and who had been on dialysis ≥ 90 days at the start of the month. Average weekly (EPO alfa, Figure 2.8.a) or monthly (darbepoetin, Figure 2.8.b & PEG-EPO beta, Figure 2.8.C) doses are shown for peritoneal dialysis patients who within a given month had a corresponding ESA claim. EPO alfa dose is expressed as mean EPO alfa units per week averaged over all a patient’s EPO alfa claims within a given month. Darbepoetin and PEG-EPO beta doses are expressed as mean units per month over all of a patient’s corresponding Darbepoetin or PEG-EPO beta claims within a given month; (d) Monthly ESA use (EPO alfa, Darbepoetin, or PEG-EPO beta) in all peritoneal dialysis patients who were ≥ 18 years and on dialysis ≥ 90 days. Abbreviations: EPO alfa, erythropoietin alfa; ESRD, end-stage renal disease; PEG-EPO beta, pegylated erythropoetin beta; ESA, erythropoiesis-stimulating agents; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.8 Anemia measures among adult peritoneal dialysis patients on dialysis ≥90 days: (a) mean monthly Hgb level and mean weekly EPO alfa dose (averaged over a month), (b) mean monthly Hgb and mean monthly darbepoetin dose, and (c) percent ESA use monthly, Medicare claims, (d) Percent monthly ESA use Data Source: Special analyses, USRDS ESRD Database. Mean monthly Hgb level among (a) EPO alfa-, (b) darbepoetin, (c)PEG-EPO beta on dialysis ≥ 90 days ( ) or (a) mean monthly Hgb level among all adult peritoneal dialysis patients (April 2012 to December 2016 only) who, within the given month, had a Hgb claim (only 1st reported Hgb value in a month were used) and were on dialysis ≥ 90 days; analyses were restricted to patients ≥ 18 years old and who had been on dialysis ≥ 90 days at the start of the month. Average weekly (EPO alfa, Figure 2.8.a) or monthly (darbepoetin, Figure 2.8.b & PEG-EPO beta, Figure 2.8.C) doses are shown for peritoneal dialysis patients who within a given month had a corresponding ESA claim. EPO alfa dose is expressed as mean EPO alfa units per week averaged over all a patient’s EPO alfa claims within a given month. Darbepoetin and PEG-EPO beta doses are expressed as mean units per month over all of a patient’s corresponding Darbepoetin or PEG-EPO beta claims within a given month; (d) Monthly ESA use (EPO alfa, Darbepoetin, or PEG-EPO beta) in all peritoneal dialysis patients who were ≥ 18 years and on dialysis ≥ 90 days. Abbreviations: EPO alfa, erythropoietin alfa; ESRD, end-stage renal disease; PEG-EPO beta, pegylated erythropoetin beta; ESA, erythropoiesis-stimulating agents; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.9 Distribution of monthly Hgb levels in ESA-treated adult peritoneal dialysis patients on dialysis ≥90 days, Medicare claims, Data Source: Special analyses, USRDS ESRD Database. Distribution of Hgb levels among peritoneal dialysis patients within a given month who had claims for Hgb level and ESA use, were on dialysis ≥90 days and ≥18 years old at the start of the month. Abbreviations: ESA, erythropoiesis-stimulating agents; ESRD, end-stage renal disease; Hgb, hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.10 Monthly IV iron use and mean monthly IV iron dose in adult peritoneal dialysis patients on dialysis ≥90 days, Medicare claims, Data Source: Special analyses, USRDS ESRD Database. Monthly IV iron use is among peritoneal dialysis patients on dialysis ≥90 days and ≥18 years old at the start of the given month. Mean IV iron dose was calculated as the average number of mg of IV iron given to all such patients during a month, among patients receiving iron during the month. Abbreviations: ESRD, end-stage renal disease; IV, intravenous. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.11 Distribution of TSAT levels in adult peritoneal dialysis patients on dialysis for at least 90 days, CROWNWeb data, May 2015, 2016, and 2017 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March to May for years 2015, 2016, and Dialysis patients on treatment for ESRD at least 90 days before the time of measurement of TSAT level for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; TSAT, transferrin saturation. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Table 2.3 TSAT by age, sex, race, and primary ESRD cause in peritoneal dialysis patients, May 2017 N TSAT <20% TSAT 20-<30% TSAT 30-<40% TSAT≥40% Overall 47,539 13.1% 31.3% 28.3% 27.3% Age 0-21 300 12.3 24.3 25.0 38.3 22-44 8,659 12.7 29.5 26.2 31.6 45-64 21,217 13.4 32.1 28.1 26.5 65-74 11,020 13.2 29.6 25.6 75+ 6,343 30.5 29.9 26.9 Sex Male 26,512 13.0 31.8 28.6 26.6 Female 21,027 13.3 30.6 28.0 28.2 Race White 31,623 13.5 28.4 Black/African American 11,611 12.4 31.3 28.5 27.9 American Indian or Alaska Native 438 15.5 25.8 Asian 3,044 11.3 33.3 Primary cause of ESRD Diabetes 18,107 32.6 29.0 Hypertension 13,487 12.6 30.2 29.1 Glomerulonephritis 8,338 30.3 26.4 30.1 Cystic Kidney 2,366 13.7 34.1 28.8 23.4 Other/Unknown 4,959 13.1 29.4 26.7 30.8 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March through May of Dialysis patients on treatment for ESRD at least 90 days before the time of measurement of TSAT level for that year, >=18 years old as of May 1, 2017 and who were alive through May 31, Table includes row percentages within demographic categories from May Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease; TSAT, transferrin saturation. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.12 Distribution of the most recent serum ferritin level taken between March and May in adult peritoneal dialysis patients on dialysis for at least 90 days, CROWNWeb data, May 2015, 2016, and 2017 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March to May for years 2015, 2016, and Dialysis patients initiating treatment for ESRD at least 90 days before the time of measurement of serum ferritin for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Figure includes row percentages within demographic categories from May Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Table 2.4 Serum ferritin by age, sex, race, and primary ESRD cause in peritoneal dialysis patients, May 2017 N Ferritin <200 ng/mL Ferritin ng/mL Ferritin ng/mL Ferritin ng/mL Ferritin >1200 ng/mL Overall 46,583 12.7 24.7 23.1 22.4 17.2 Age 0-21 289 30.5 24.9 19.0 14.9 10.7 22-44 8,488 14.3 27.6 22.6 21.0 14.4 45-64 20,796 12.1 24.5 23.5 22.7 17.3 65-74 10,787 12.0 23.3 22.9 23.4 18.5 75+ 6,223 12.6 23.7 21.7 18.8 Sex Male 25,983 13.3 26.4 21.6 15.1 Female 20,600 11.9 22.5 19.9 Race White 30,960 14.1 25.9 21.5 Black/African American 11,366 9.5 24.3 21.9 American Indian or Alaska Native 441 12.5 32.0 18.1 15.0 Asian 2,997 10.0 23.0 23.6 21.1 Primary cause of ESRD Diabetes 17,709 11.6 25.6 22.3 16.0 Hypertension 13,233 18.9 Glomerulonephritis 8,164 22.1 Cystic Kidney 2,311 20.9 29.0 20.2 10.9 Other/Unknown 4,892 12.9 24.0 23.2 21.3 18.6 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for March to May Dialysis patients initiating treatment for ESRD at least 90 days before the time of measurement of serum ferritin for that year, ≥18 years old as of May 1, 2017, and who were alive through May 31, Table includes row percentages within demographic categories from May Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.13 Percentage of all adult peritoneal dialysis patients (a) by number of red blood cell transfusions received in a year, and (b) with ≥1 claims for a red blood cell transfusion in a month, from Medicare claims data overall, within 90 days and after at least 90 days of first PD session, (a) Number of red blood cell transfusions received in a year Data Source: Special analyses, USRDS ESRD Database. (a) The percent of peritoneal dialysis patients ≥18 years with total number of red blood cell transfusion claims in a given year among dialysis patients having a claim for at least one peritoneal dialysis session during the year. (b) The percentage of peritoneal dialysis patients with ≥1 red blood cell transfusion claims in a given month was among peritoneal dialysis patients having a claim for at least one dialysis session during the month, and who were ≥18 years old at the start of the month. Additional analysis of RBC transfusion claims completed for patients on dialysis for < 90 days or ≥ 90 days. Abbreviations: ESRD, end- stage renal disease; RBC, red blood cell. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.13 Percentage of all adult peritoneal dialysis patients (a) by number of red blood cell transfusions received in a year, and (b) with ≥1 claims for a red blood cell transfusion in a month, from Medicare claims data overall, within 90 days and after at least 90 days of first PD session, (b) Percent of all patients on dialysis <90 days, or patients on dialysis ≥ 90 days, who had ≥1 claim for a red blood cell transfusion in a month Data Source: Special analyses, USRDS ESRD Database. (a) The percent of peritoneal dialysis patients ≥18 years with total number of red blood cell transfusion claims in a given year among dialysis patients having a claim for at least one peritoneal dialysis session during the year. (b) The percentage of peritoneal dialysis patients with ≥1 red blood cell transfusion claims in a given month was among peritoneal dialysis patients having a claim for at least one dialysis session during the month, and who were ≥18 years old at the start of the month. Additional analysis of RBC transfusion claims completed for patients on dialysis for < 90 days or ≥ 90 days. Abbreviations: ESRD, end- stage renal disease; RBC, red blood cell. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.14 Distribution of serum calcium levels in adult hemodialysis patients on dialysis for at least 1 year, CROWNWeb data, May 2015, 2016, and 2017 Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for May for years 2015, 2016, and Dialysis patients on treatment for ESRD at least 1 year at the time of measurement of serum calcium for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.15 Distribution of serum calcium levels in adult peritoneal dialysis patients on dialysis for at least 1 year, CROWNWeb data, May 2015, 2016, and 2017 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for May for years 2015, 2016, and Dialysis patients on treatment for ESRD at least 1 year at the time of measurement of serum calcium for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.16 Distribution of serum phosphorus levels in adult hemodialysis patients on dialysis for at least 1 year, CROWNWeb data, May 2015, 2016, and 2017 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for May 2015, May 2016, and May Dialysis patients on treatment for ESRD at least 1 year at the time of measurement of serum phosphorus for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web- Enabled Network; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.17 Distribution of serum phosphorus levels in adult peritoneal dialysis patients on dialysis for at least 1 year, CROWNWEB data, May 2015, 2016, and 2017 Data Source: Special analyses, USRDS ESRD Database. CROWNWeb clinical extracts for May 2015, May 2016, and May Dialysis patients on treatment for ESRD at least 1 year at the time of measurement of serum phosphorus for that year, ≥18 years old as of May 1 of that year and who were alive through May 31 of that year. Abbreviations: CROWNWeb, Consolidated Renal Operations in a Web-Enabled Network; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.18 Diabetes-related care among ESRD patients with diabetes mellitus aged years, Medicare claims, Data Source: Special analyses, USRDS ESRD Database. Point prevalent Medicare ESRD patients aged 18 to 75 years with a diagnosis claim for diabetes mellitus in the previous year; diabetes-related care in the measurement year. Abbreviations: ESRD, end-stage renal disease; HbA1c, glycosylated hemoglobin. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.19 Percentage of ESRD patients with a claim for seasonal influenza vaccination (August 1-April 30 of subsequent year), (a) overall, (b) by age and hemodialysis treatment, (c) by age and peritoneal dialysis, (d) by age and transplantation, (e) by race, and (f) by ethnicity, Medicare data, (a) Overall Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating treatment for ESRD at least 90 days before seasonal period: August 1-April 30 for influenza. (c) Native Hawaiian/Pacific Islander, Multiracial, and Other/Unknown races excluded due to small number of flu vaccination claims. Abbreviations: AI, American Indian; AN, Alaska Native; Blk/Af Am, Black/African American; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.19 Percentage of ESRD patients with a claim for seasonal influenza vaccination (August 1-April 30 of subsequent year), (a) overall, (b) by age and hemodialysis treatment, (c) by age and peritoneal dialysis, (d) by age and transplantation, (e) by race, and (f) by ethnicity, Medicare data, (b) Age and hemodialysis treatment Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating treatment for ESRD at least 90 days before seasonal period: August 1-April 30 for influenza. (c) Native Hawaiian/Pacific Islander, Multiracial, and Other/Unknown races excluded due to small number of flu vaccination claims. Abbreviations: AI, American Indian; AN, Alaska Native; Blk/Af Am, Black/African American; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.19 Percentage of ESRD patients with a claim for seasonal influenza vaccination (August 1-April 30 of subsequent year), (a) overall, (b) by age and hemodialysis treatment, (c) by age and peritoneal dialysis, (d) by age and transplantation, (e) by race, and (f) by ethnicity, Medicare data, (c) Age and peritoneal dialysis Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating treatment for ESRD at least 90 days before seasonal period: August 1-April 30 for influenza. (c) Native Hawaiian/Pacific Islander, Multiracial, and Other/Unknown races excluded due to small number of flu vaccination claims. Abbreviations: AI, American Indian; AN, Alaska Native; Blk/Af Am, Black/African American; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.19 Percentage of ESRD patients with a claim for seasonal influenza vaccination (August 1-April 30 of subsequent year), (a) overall, (b) by age and hemodialysis treatment, (c) by age and peritoneal dialysis, (d) by age and transplantation, (e) by race, and (f) by ethnicity, Medicare data, (d) Age and transplantation Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating treatment for ESRD at least 90 days before seasonal period: August 1-April 30 for influenza. (c) Native Hawaiian/Pacific Islander, Multiracial, and Other/Unknown races excluded due to small number of flu vaccination claims. Abbreviations: AI, American Indian; AN, Alaska Native; Blk/Af Am, Black/African American; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.19 Percentage of ESRD patients with a claim for seasonal influenza vaccination (August 1-April 30 of subsequent year), (a) overall, (b) by age and hemodialysis treatment, (c) by age and peritoneal dialysis, (d) by age and transplantation, (e) by race, and (f) by ethnicity, Medicare data, (e) Race Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating treatment for ESRD at least 90 days before seasonal period: August 1-April 30 for influenza. (c) Native Hawaiian/Pacific Islander, Multiracial, and Other/Unknown races excluded due to small number of flu vaccination claims. Abbreviations: AI, American Indian; AN, Alaska Native; Blk/Af Am, Black/African American; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

vol 2 Figure 2.19 Percentage of ESRD patients with a claim for seasonal influenza vaccination (August 1-April 30 of subsequent year), (a) overall, (b) by age and hemodialysis treatment, (c) by age and peritoneal dialysis, (d) by age and transplantation, (e) by race, and (f) by ethnicity, Medicare data, (f) Ethnicity Data Source: Special analyses, USRDS ESRD Database. ESRD patients initiating treatment for ESRD at least 90 days before seasonal period: August 1-April 30 for influenza. (c) Native Hawaiian/Pacific Islander, Multiracial, and Other/Unknown races excluded due to small number of flu vaccination claims. Abbreviations: AI, American Indian; AN, Alaska Native; Blk/Af Am, Black/African American; ESRD, end-stage renal disease. 2018 Annual Data Report Volume 2 ESRD, Chapter 2

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