The United States Renal Data System 2023 Annual Data Report (ADR) contains updated information about the chronic kidney disease (CKD) and end-stage renal disease (ESRD) populations in the United States through the end of 2021. As such, it offers information about ESRD incidence, prevalence, and outcomes during the second year of the COVID-19 pandemic, in which the more transmissible delta variant became dominant, and during the first year of implementation of the ESRD Treatment Choices (ETC) payment model.

DataReport (ADR) contains data from medical claims through 2020 and for some end-stage renal disease (ESRD)-related metrics through the first half of 2021.As such, this is the first year in which the wide-ranging effects of the coronavirus disease 2019 (COVID-19) pandemic on the chronic kidney disease (CKD) and ESRD populations can be placed into the full context of the years that preceded its onset.Another important aspect of this year's ADR is a continued focus on racial, ethnic, and socioeconomic disparities in access to health care and outcomes.Unfortunately, these 2 topics intersect in the form of racial and ethnic disparities in vulnerability and susceptibility to COVID-19 that further exposed and exacerbated preexisting disparities in incidence, prevalence, and care of patients with kidney disease. Direct and Indirect Effects of COVID-19 on the CKD and ESRD PopulationsThe devastating effects of the COVID-19 pandemic on the CKD and ESRD populations permeate the 2022 ADR.The 2022 ADR includes data on medical care and outcomes through calendar year 2020 (although some data for the first half of 2021 for the ESRD population are included).Although we presented early views into the impact of the COVID-19 pandemic on the ESRD population in the 2020 ADR and expanded these analyses to include examination of COVID-19 diagnoses and outcomes in the CKD population in the 2021 ADR, the full magnitude of the direct and indirect effects of the pandemic on these populations comes into sharp focus throughout this year's report.The direct effects of COVID-19 can be measured by examining patterns of patient testing, hospitalization, and mortality.More than 10% of patients with CKD, 13% of patients with a kidney transplant, and 20% of patients receiving dialysis in January of 2020 were diagnosed with COVID-19 by the end of June 2021, rates that were approximately 50%, 100%, and 200% higher than that of Medicare beneficiaries without CKD, respectively.Although the incidence of COVID-19 testing was higher among individuals with CKD, the incidence of hospitalization after COVID-19 diagnosis among patients with CKD was more than double that of patients without CKD in 2020; patients receiving dialysis consistently had

The US Renal Data System (USRDS) Annual Data Report (ADR) is an authoritative source of data about the chronic kidney disease (CKD) and kidney failure populations in the United States. Herein, we will refer to the latter using the Centers for Medicare & Medicaid Services (CMS) term, end-stage renal disease (ESRD). Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health and the CMS, the USRDS Coordinating Center is operated by the Chronic Disease Research Group within the Hennepin Healthcare Research Institute in Minneapolis, Minnesota. The 2020 ADR contains the most current US surveillance data on incidence, prevalence, and outcomes of CKD, acute kidney injury (AKI), and ESRD. According to recent data from the National Health and Nutrition Examination Survey, the prevalence of CKD among adults in the United States has been relatively stable at just under 15% for the last 15 years. At the same time, the number of individuals with key risk factors such as older age, diabetes, and hypertension has increased. Thus, stable rates of CKD reflect lower rates among individuals with these risk factors. Rates of hospitalizations during which AKI occurs have been rising in the Medicare population, but the rate of AKI requiring dialysis has been stable over the past decade. Turning to ESRD, the unadjusted incidence has risen over the last 20 years and continues to increase. However, it has risen more slowly in recent years, and its adjusted incidence has declined from a peak in 2006. By contrast, the adjusted prevalence of ESRD has steadily increased, primarily owing to declining mortality among patients with ESRD. ESRD prevalence in the United States remains one of the highest in the world at 2,242 cases per million population in 2018. The rate of kidney transplantation among patients receiving dialysis increased in 2018 to 3.6 per 100 person-years, continuing a trend that started in 2014 after years of steady decline. At the end of 2018, there were 554,038 patients undergoing dialysis and 229,887 patients with a functioning kidney transplant in the United States. These data do not capture patients with ESRD who chose to forego dialysis or transplantation and were being managed using conservative means, a strategy that has garnered increasing attention in recent years. Racial disparities in rates of CKD and ESRD and in access to kidney transplantation have been widely appreciated and remain evident in the 2020 ADR. However, there is evidence of some progress. The incidence of ESRD among Black individuals decreased by 20% between 2008 and 2018, narrowing the gap between Black and White patients somewhat. Nevertheless, the incidence remained more than 2.5 times higher among Black individuals in 2018. The rate of deceased donor kidney transplantation increased among Black patients receiving dialysis and now equals that among White patients. However, the rate of living donor transplantation among Black patients still lagged substantially. This year’s ADR also incorporates new information, including a chapter focusing on patients’ preferences about end-of-life care and a supplemental chapter describing the early impact of coronavirus disease 2019 (COVID-19) on the ESRD population. Information about patients’ prognostic expectations and end-of-life treatment preferences was drawn from participants in the USRDS Study of Treatment Preferences. Just over 40% of patients were uncertain of their prognosis, and over half of the remainder anticipated surviving for 10 years or longer despite a statistically estimated survival of less than 10 years among prevalent dialysis patients over 44 years of age. Patients’ prognostic expectations may have influenced their engagement in end-of-life preparations and discussions as well as their preferences for end-of-life care. Those with more optimistic expectations were less likely to have documented a surrogate decision maker or considered end-of-life preferences, whereas they were more likely to prioritize life prolongation over relief of discomfort and to favor receipt of cardiopulmonary resuscitation. These findings suggest missed opportunities to discuss expected prognosis and goals of care with patients receiving dialysis. Timely analyses on COVID-19 in the ESRD population were possible using data in the CMS Renal Management Information System extracts. During the first half of 2020, there were 11,200 COVID-19 hospitalizations among Medicare beneficiaries undergoing dialysis. Compared with the same periods in 2017-2019, all-cause mortality among all patients receiving dialysis in 2020 was 37% higher from March 29 to April 25 and 16% higher from April 26 to July 4. Among patients with a functioning kidney transplant, corresponding estimates of excess mortality were 61% and 25%. Between mid-March and mid-May, the number of ESRD patients with incident ESRD was 20% lower than average cumulative counts during the same period in 2017-2019. Thus, the impact of COVID-19 on the ESRD population in the United States was profound during the first half of 2020. The ADR is published at the USRDS website (www.usrds.org) and as a supplement to AJKD. This year, the ADR available at the USRDS website is presented in a new, interactive format. The report was designed with the data at the center so that tables and figures are juxtaposed with brief explanatory text. In most cases, figures can be customized by the reader to display data stratified by patient characteristics and/or to show unadjusted values or values adjusted for patient demographic characteristics or for inflation. As a result, some figures have many more possible configurations in the online ADR than can be reproduced in the journal supplement version. Therefore, the investigative team has curated the content for presentation in AJKD, sifting through the material presented in each figure to select the versions that display the most noteworthy findings. Readers who wish to view alternative or additional displays may visit the interactive ADR at https://adr.usrds.org/2020. Johansen KL, Chertow GM, Foley RN, et al. US Renal Data System 2020 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2021;77(4)(suppl 1):Svii-Sviii, S1-S597. Funding for the USRDS Coordinating Center is provided under contract to Hennepin Healthcare Research Institute ( 75N94019C00006 ). Dr Johansen reports personal fees from GSK and American Society of Nephrology (ASN). Dr Chertow reports personal fees from Satellite Healthcare, Akebia, Amgen, Ardelyx, AstraZeneca, Baxter, Cricket, DiaMedica, Gilead, Reata, Sanifit, Vertex, Angion, Bayer, and ReCor; additionally, he reports serving on advisory boards for Ardelyx, CloudCath, Durect, and Outset. Dr Foley reports personal fees from Novartis, FibroGen, and AstraZeneca. Dr Gilbertson received consulting income from Amgen. Dr Herzog reports grants and/or personal fees from National Heart Lung and Blood Institute (NHLBI/NIH), NIH/NIDDK, Abbvie, Amgen, AstraZeneca, Corvidia, Diamedica, FibroGen, Janssen, NxStage, Pfizer, Relypsa, Sanifit, University of Oxford, Bristol-Myers Squibb, University of British Columbia, UpToDate, Bayer, and Johnson & Johnson. Dr Israni reports participatation on an advisory board for CSL Behring. Dr Ku reports grant support from Care DX, personal fees from Tricida, and advisory board participation for Reata. Dr Obrador reports grant funding from Rio Arronte Foundation and Secretariat of Education, Science, Technology and Innovation of Mexico City; advisory board participation for Johnson & Johnson’s CREDENCE trial, GlaxoSmithKline’s ASCEND trial, Gilead's MOSAIC trial, GlaxoSmithKline, Vifor, and Roche Mexico; speaker fees/honoraria from AstraZeneca, Amgen Mexico, Seminars in Nephrology, and AbbVie Mexico; and royalties from Elsevier Barcelon and UpToDate. Dr O’Hare reports personal fees from Chugai, UpToDate, Fondation D.E.V.E.N.I.R., ASN, Hammersmith Hospital, and travel fees from Health and Aging Policy Program. Dr St. Peter reports serving on advisory boards for Kidney Health Initiative and National Kidney Foundation, and personal fees from Quality Insights, OptumLabs, and Total Renal Care, Inc. (DaVita). Dr Snyder reports research funding from CSL Behring, Atara Biotherapeutics, Bristol-Myers Squibb, and Astellas; membership in the Board of Directors for Donate Life America and Organ Donation and Transplantation Alliance; and membership in the Medical Policy Board at LifeSource Upper Midwest Organ Procurement Organization. Dr Weinhandl was employed by NxStage Medical and Fresenius Medical Care North America, and reports a consulting relationship with Fresenius Medical Care North America. Dr Winkelmayer reports personal fees from Akebia, AstraZeneca, Bayer, Daichii-Sankyo, Janssen, Otsuka, Reata, Relypsa, and Vifor FMC Renal Pharma. Dr Wetmore reports personal fees from Reata and Rockwell Medical. The remaining authors declare that they have no relevant financial interests. Publications based upon USRDS data reported here must include a citation and the following notice: The data reported here have been supplied by the US Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.

Introduction: Among kidney transplant recipients (KTRs) with end-stage kidney disease (ESKD) due to atypical hemolytic uremic syndrome (aHUS), recurrence is associated with poor allograft outcomes. We compared graft and patient survival of aHUS KTRs with and without prophylactic/early use of eculizumab, a monoclonal antibody that binds complement protein C5, at the time of transplantation. Methods: We conducted a retrospective cohort study using the United States Renal Data System. Out of 123 624 ESKD patients transplanted between January 1, 2008, and June 1, 2016, we identified 348 (0.28%) patients who had “hemolytic uremic syndrome” as the primary cause of ESKD. We then linked these patients to datasets containing the Healthcare Common Procedure Coding System (HCPCS) code for eculizumab infusion. Patients who received eculizumab prior to or within 30 days of transplant represented the exposure group. We calculated crude incidence rates and conducted exact logistic regression, adjusted for recipient age and sex, for the study outcomes of graft loss, death-censored graft loss, and mortality. We also estimated the average treatment effect (ATE) by propensity-score matching, to reduce the bias in the estimated treatment effect on graft loss. Results: Our final study cohort included 335 aHUS KTRs (23 received eculizumab, 312 did not), with a mean duration of follow-up of 5.8 ± 2.7 years. There were no significant differences in baseline demographic and clinical characteristics between the eculizumab versus non-eculizumab group. Patients who received prophylactic/early eculizumab were less likely to experience graft loss compared with those who did not receive eculizumab (0% vs 20%, P = .02), with an adjusted odds ratio of 0.13 ( P = .02). In the propensity-score-matched sample, the ATE (eculizumab vs non-eculizumab) was −0.20 (95% confidence interval [CI] = −0.25 to −0.15, P < .001); thus, treatment was associated with an average of 20% reduction in graft loss. There was no significant difference in the risk of death between the 2 groups. Conclusions: Although there was no significant difference in the risk of death, prophylactic/early use of eculizumab was significantly associated with improved graft survival among aHUS KTRs. Given the high cost of eculizumab, randomized controlled trials are much needed to guide prophylactic strategies to prevent graft loss.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD56)1 Apr 2020PD56-03 NATIONAL SURGICAL TRENDS IN LOWER URINARY TRACT SYMPTOMS ASSOCIATED WITH BENIGN PROSTATIC HYPERPLASIA Charles Welliver*, Lydia Feinstein, Julia B. Ward, Kevin C. Abbott, Tamara Bavendam, Ziya Kirkali, Erline Martinez-Miller, Brian R. Matlaga, and Kevin McVary Charles Welliver*Charles Welliver* More articles by this author , Lydia FeinsteinLydia Feinstein More articles by this author , Julia B. WardJulia B. Ward More articles by this author , Kevin C. AbbottKevin C. Abbott More articles by this author , Tamara BavendamTamara Bavendam More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Erline Martinez-MillerErline Martinez-Miller More articles by this author , Brian R. MatlagaBrian R. Matlaga More articles by this author , and Kevin McVaryKevin McVary More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000966.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a chronic disease causing significant morbidity and quality of life impairment among men. Pharmacotherapy is the common treatment, and surgical management is often reserved for refractory disease. Our current understanding of trends in surgical treatment of BPH is limited to studies that predominantly focus on older men. We assessed trends in the surgical management of LUTS/BPH across 10 years in a large, national sample of older and working aged men. METHODS: As part of the Urologic Diseases in America project, we analyzed two insurance claims databases over the 2004-2013 study period: the Centers for Medicare & Medicaid Services Medicare 5% Sample for male Medicare beneficiaries aged ≥65 years with LUTS/BPH (N≈147,800 annually) and the Optum© de-identified Clinformatics® Data Mart Database for privately insured males aged 40-64 years with LUTS/BPH (N≈100,300 annually). We examined age and temporal trends in the percentage of patients who underwent surgery to treat LUTS/BPH. Surgical procedures included: open prostatectomy (OP), transurethral needle ablation (TUNA), transurethral resection of the prostate (TURP), laser prostatectomy (LP), Transurethral incision of the prostate (TUIP), and transurethral microwave therapy (TUMT). RESULTS: Surgical procedure prevalence and time trends varied by age (Figure 1). Throughout the study period, surgical treatment of LUTS/BPH was higher among patients ≥65 years of age compared to patients 40-60 years of age (3-5% vs. 2%). Surgical procedures for LUTS/BPH decreased by 40% over the study period in the older population but remained stable in the younger population. Among older patients, TURP was most commonly utilized (45%), followed by LP (30%), TUMT (17%), TUNA (5%), OP (2%) and TUIP (1%). Among younger patients, TURP (38%) was more closely followed by LP (31%) and then TUMT (18%), TUNA (8%), TUIP (3%) and OP (2%). CONCLUSIONS: Over a 10-year span, older LUTS/BPH patients had a higher prevalence of surgical procedures than younger LUTS/BPH patients, and TURP and LP were the most commonly performed procedures. There was a dramatic reduction in surgical therapy for LUTS/BPH among older but not younger patients. Source of Funding: Funded by the NIH via a contract to Social & Scientific Systems. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1188-e1189 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Welliver* More articles by this author Lydia Feinstein More articles by this author Julia B. Ward More articles by this author Kevin C. Abbott More articles by this author Tamara Bavendam More articles by this author Ziya Kirkali More articles by this author Erline Martinez-Miller More articles by this author Brian R. Matlaga More articles by this author Kevin McVary More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND Because stroke prevention is a major goal in the management of ESKD hemodialysis patients with atrial fibrillation, investigating racial/ethnic disparities in stroke among such patients is important to those who could benefit from strategies to maximize preventive measures. METHODS We used the United States Renal Data System to identify ESKD patients who initiated hemodialysis from 2006 to 2013 and then identified those with a subsequent atrial fibrillation diagnosis and Medicare Part A/B/D. Patients were followed for 1 year for all-cause stroke, mortality, prescription medications, and cardiovascular disease procedures. The survival mediational g-formula quantified the percentage of excess strokes attributable to lower use of atrial fibrillation treatments by race/ethnicity. RESULTS The study included 56,587 ESKD hemodialysis patients with atrial fibrillation. Black, white, Hispanic, and Asian patients accounted for 19%, 69%, 8%, and 3% of the population, respectively. Compared with white patients, black, Hispanic, or Asian patients were more likely to experience stroke (13%, 15%, and 16%, respectively) but less likely to fill a warfarin prescription (10%, 17%, and 28%, respectively). Warfarin prescription was associated with decreased stroke rates. Analyses suggested that equalizing the warfarin distribution to that in the white population would prevent 7%, 10%, and 12% of excess strokes among black, Hispanic, and Asian patients, respectively. We found no racial/ethnic disparities in all-cause mortality or use of cardiovascular disease procedures. CONCLUSIONS Racial/ethnic disparities in all-cause stroke among hemodialysis patients with atrial fibrillation are partially mediated by lower use of anticoagulants among black, Hispanic, and Asian patients. The reasons for these disparities are unknown, but strategies to maximize stroke prevention in minority hemodialysis populations should be further investigated.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (PD21)1 Apr 2020PD21-11 PREVALENCE OF URINARY INCONTINENCE AMONG A NATIONALLY REPRESENTATIVE SAMPLE OF ADULT WOMEN: FINDINGS FROM THE UROLOGIC DISEASES IN AMERICA PROJECT Una J. Lee*, Lydia Feinstein, Julia B. Ward, Kevin C. Abbott, Tamara Bavendam, Ziya Kirkali, Erline Martinez-Miller, Brian R. Matlaga, and Kathleen C. Kobashi Una J. Lee*Una J. Lee* More articles by this author , Lydia FeinsteinLydia Feinstein More articles by this author , Julia B. WardJulia B. Ward More articles by this author , Kevin C. AbbottKevin C. Abbott More articles by this author , Tamara BavendamTamara Bavendam More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Erline Martinez-MillerErline Martinez-Miller More articles by this author , Brian R. MatlagaBrian R. Matlaga More articles by this author , and Kathleen C. KobashiKathleen C. Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000871.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) is a common and impactful condition that affects women across their lifetime. Our knowledge of the burden of UI at a nation-wide level remains limited and is likely underreported in clinical data. Using 7 years of data from a large, nationally representative sample of US adult women, we assessed the prevalence, severity, and impact on daily life of UI and its subtypes. METHODS: We used data from the 2005-2012 National Health and Nutrition Examination Survey, a cross-sectional multistage stratified probability sample of the U.S. civilian non-institutionalized population. Our study comprised 9423 non-pregnant women aged ≥20 years with complete UI data. Women who reported UI symptoms in the prior year were considered to have UI. We estimated the 12-month prevalence of UI, overall and by UI sub-group (stress, urgency, or mixed). Among women with UI, we additionally assessed symptom severity using the validated 4-level Incontinence Severity Index (none, slight, moderate, or severe), as well as impact on daily activities. All analyses accounted for the NHANES complex survey design and sampling. RESULTS: The average annual prevalence of any UI among women was 54%, with mimimal change over time. Stratifying by UI subtypes, 16% had mixed, 26% had stress only, and 11% had urgency only. Prevalence of any UI increased with age, although this pattern varied by UI subtype (Figure 1). While urgency UI was highest among the oldest age group, stress UI was highest among those aged 45-54 years and mixed UI among those aged 65-69 years. Among women with UI, 32% of women reported moderate or severe symptoms. Older women had a higher prevalence of moderate or severe UI symptoms compared to younger women (55% among those aged 80+ years vs. 16% among those aged 20-34 years). Twenty-two percent of women with UI reported that UI affected their daily activities. CONCLUSIONS: Our study demonstrated high prevalence of UI among a nationally representative population of US women that remained stable over the study period, with stress UI as the most common subtype. Over 20% of women with UI reported that the condition affected their daily lives, with a substantial increase in UI severity with increasing age. Source of Funding: Funded by the NIH via a contract to Social & Scientific Systems © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e457-e458 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Una J. Lee* More articles by this author Lydia Feinstein More articles by this author Julia B. Ward More articles by this author Kevin C. Abbott More articles by this author Tamara Bavendam More articles by this author Ziya Kirkali More articles by this author Erline Martinez-Miller More articles by this author Brian R. Matlaga More articles by this author Kathleen C. Kobashi More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: Medication use for lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) increases with patient age. However, little is known about prescribing patterns as men in their 60’s transition from private insurance to Medicare coverage. We characterized differences in LUTS/BPH medication prescribing patterns among a large, national sample of 60- to 69-year-olds. METHODS: As part of the Urologic Diseases in America project, two insurance claims databases were analyzed over the 2006-2013 study period: the Centers for Medicare & Medicaid Services Medicare (CMS) 5% Sample for Medicare beneficiaries and the Optum© de-identified Clinformatics® Data Mart Database (CDM) for privately insured adults. We compared patterns for LUTS/BPH prescription fills between privately insured men aged 60-64 years with LUTS/BPH (N≈38,300 annually) and Medicare beneficiaries aged 65-69 years with LUTS/BPH (N≈28,700 annually). CMS data for 2012 was unavailable. RESULTS: Prescribing of any LUTS/BPH medication was higher among Medicare beneficiaries (range: 50-55%) than among privately insured men (range: 41-49%), but there was a greater rise in prescribing over time for the privately insured group (17% vs. 5%). The largest difference in medication use was with α-blocker therapy, which was 20% higher on average in the Medicare group (range: 41-45%) compared to the privately insured group (range: 32-38%). Anticholinergic prescribing was uncommon (6% for Medicare vs. 3-4% for private insurance) and remained relatively steady over the study period. 5αRI prescribing increased up to 2010, then decreased in both groups, with a less pronounced decline among Medicare beneficiaries (9% vs. 14%). Tadalafil prescribing was more common in privately insured patients (5-8%) than among Medicare beneficiaries (0.1-3%). CONCLUSIONS: Overall, there was a rise in LUTS/BPH pharmacotherapy for sexagenarians from 2006-2013, with a greater rise among privately insured enrollees relative to Medicare beneficiaries. The decline in 5αRI prescribing correlates to the FDA “black box” warning on finasteride in 2011. Tadalafil coverage was rarely prescribed to Medicare beneficiaries.Source of Funding: Funded by the NIH via a contract to Social & Scientific Systems.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making III (PD32)1 Apr 2020PD32-01 NATIONAL PRESCRIBING TRENDS AMONG ADULTS WITH URINARY TRACT INFECTIONS: FINDINGS FROM THE UROLOGIC DISEASES IN AMERICA PROJECT Lydia Feinstein*, Brian R. Matlaga, Kevin C. Abbott, Tamara Bavendam, Ziya Kirkali, Erline Martinez-Miller, and Julia B. Ward Lydia Feinstein*Lydia Feinstein* More articles by this author , Brian R. MatlagaBrian R. Matlaga More articles by this author , Kevin C. AbbottKevin C. Abbott More articles by this author , Tamara BavendamTamara Bavendam More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Erline Martinez-MillerErline Martinez-Miller More articles by this author , and Julia B. WardJulia B. Ward More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000896.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Concerns of multidrug resistance may be influencing prescribing practices for urinary tract infections (UTI). We assessed 10-year trends in pharmacotherapy for UTI among a large sample of US adults treated in outpatient settings. METHODS: We assessed trends in the prevalence of UTI-related prescription fills and medication duration from 2007-2016. To assess trends among those aged 18-64 years (N= 2,691,529 UTI episodes), we utilized the Optum© Clinformatics® Data Mart (CDM), a de-identified administrative claims database that includes individuals covered by commercial insurance in all 50 US states. For analyses among those aged ≥65 years (N=874,043 UTI episodes), we utilized the Medicare 5% Sample. UTI was defined as an outpatient claim with a UTI-related diagnosis code followed by a pharmacy claim for an anti-infectious agent within 72 hours. RESULTS: The most commonly used medications were quinolones, urinary anti-infectives, and sulfonamides (Table 1). Quinolone use was more common among men compared to women, while urinary anti-infective use was more common among women. The mean duration of medication use was 8 days, with variation by medication type (range: 5-16 days). Over time, quinolone use decreased while the use of urinary anti-infectives, cephalosporins, and combination therapy including azoles increased (Figure 1). CONCLUSIONS: Pharmacological treatment of UTI evolved over the 10-year study period, shifting from a primarily quinolone-based treatment paradigm to a more diverse pharmaceutical armamentarium that increasingly relied on cephalosporin agents. This evolution was likely driven by resistance patterns that particularly impact the effectiveness of quinolone agents. Nevertheless, regardless of the antibacterial agent used, treatment duration appeared to be longer than what guidelines typically suggest, representing an opportunity for practice improvement. Source of Funding: Funded by the NIH via a contract to Social & Scientific Systems. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e636-e636 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lydia Feinstein* More articles by this author Brian R. Matlaga More articles by this author Kevin C. Abbott More articles by this author Tamara Bavendam More articles by this author Ziya Kirkali More articles by this author Erline Martinez-Miller More articles by this author Julia B. Ward More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) is a chronic disease causing significant morbidity and quality of life impairment among adult men. Pharmacotherapy is the most common initial intervention, but our current understanding of medication usage trends for LUTS/BPH is incomplete and prior studies have relied on limited datasets that have predominantly focused on older men. We assessed trends in the pharmacological management of LUTS/BPH among a national sample of men with private and Medicare insurance over an 8-year period. METHODS: As part of the Urologic Diseases in America project, two insurance claims databases were analyzed over the 2006-2013 study period: the Centers for Medicare & Medicaid Services Medicare (CMS) 5% Sample for an annual average of 105,180 male Medicare beneficiaries aged ≥65 years with LUTS/BPH and the Optum© de-identified Clinformatics® Data Mart Database (CDM) for an annual average of 104,766 privately insured males aged 40-64 years with LUTS/BPH. The percentage of patients receiving LUTS/BPH-related prescriptions was assessed annually over the study period and stratified by 5-year age groups. RESULTS: Use of prescription medications for LUTS/BPH increased throughout the study period (see Figure). The increase was greater for men with private insurance as compared to Medicare (14% vs 5% increase). The proportion of patients who filled prescriptions increased with increasing age, with up to 67% of LUTS/BPH patients aged 85+ years filling prescriptions in 2013. CONCLUSIONS: Over an 8-year study period, BPH was increasingly managed with pharmacotherapy. This increase was especially pronounced among younger men with private insurance. This analysis is unique in that the utilization of administrative claims data allowed for assessment of prescribing trends across different care delivery settings and among a large national sample of men as young as 40 years of age.Source of Funding: Funded by the NIH via a contract to Social & Scientific Systems.

Racial disparities in kidney transplant outcomes are well documented and are attributed to biologic differences ( e.g. , gene variants in APOL1), immunologic factors, and other barriers, including lower socioeconomic status (SES), nonadherence to immunosuppressive medications, reduced access to care

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures (MP27)1 Apr 2020MP27-03 ECONOMIC COST OF URINARY INCONTINENCE FOR INSURED ADULT WOMEN IN THE UNITED STATES, 2004-2013 Kathleen C. Kobashi*, Julia B. Ward, Lydia Feinstein, Kevin C. Abbott, Tamara Bavendam, Ziya Kirkali, Erline Martinez-Miller, Brian R. Matlaga, and Una J. Lee Kathleen C. Kobashi*Kathleen C. Kobashi* More articles by this author , Julia B. WardJulia B. Ward More articles by this author , Lydia FeinsteinLydia Feinstein More articles by this author , Kevin C. AbbottKevin C. Abbott More articles by this author , Tamara BavendamTamara Bavendam More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , Erline Martinez-MillerErline Martinez-Miller More articles by this author , Brian R. MatlagaBrian R. Matlaga More articles by this author , and Una J. LeeUna J. Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000866.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) is a common and impactful condition that affects women across their lifetime. However, the economic cost of UI in the United States is not well understood. We examined insurer expenditures on UI services among a national sample of insured adult women in the United States between 2004-2013. METHODS: The two data sources used in this study included the Optum© de-identified Clinformatics® Data Mart Database (CDM) for privately insured female enrollees aged 18-64 years with UI (N≈36,600 annually) and the Centers for Medicare and Medicaid Services Medicare 5% Sample female beneficiaries aged 65+ years with UI (N≈46,900 annually). Annual UI-related expenditures from 2004-2013 were calculated overall and by age, race/ethnicity, and service location. RESULTS: Expenditures for UI services in the Medicare population remained stable at ∼$200 per person a year; however, these expenditures varied by race. From 2004-2013, per patient expenditures increased among White women from $199 in 2004 to $217 and decreased among Black women from $147 in 2004 to $102 in 2013. For privately insured patients, annual per-person expenditures decreased from $1,401 in 2004 to $932 in 2013. Expenditures in this privately insured sector were also higher for White and Hispanic women than Black and Asian women, a trend that persisted across the time period studied. The service location for expenditures shifted drastically over time in both populations. Among Medicare UI patients, inpatient expenditures made up 22% of total expenditures in 2004, decreasing to 3% by 2013. Correspondingly, outpatient expenditures increased from 31% in 2004 to 60% in 2013. Among privately insured patients, inpatient expenditures decreased from 35% of total expenditures in 2004 to 6% in 2013, while outpatient expenditures increased from 43% to 74%. CONCLUSIONS: We provide one of the most comprehensive examinations of UI expenditures among an insured adult population to date, demonstrating persistent racial/ethnic disparities in spending and a shift to outpatient treatment. Better understanding of the healthcare expenditures for UI provides a platform upon which to potentially improve utilization of resources and selection of therapeutic options for patients. Source of Funding: Funded by the NIH via a contract to Social & Scientific Systems. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e410-e410 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathleen C. Kobashi* More articles by this author Julia B. Ward More articles by this author Lydia Feinstein More articles by this author Kevin C. Abbott More articles by this author Tamara Bavendam More articles by this author Ziya Kirkali More articles by this author Erline Martinez-Miller More articles by this author Brian R. Matlaga More articles by this author Una J. Lee More articles by this author Expand All Advertisement PDF downloadLoading ...