The Peer Kidney Care Initiative ("Peer") is a collaborative quality initiative that makes use of population data to inform patients, physicians, dialysis provider organizations, payers, and governmental units about the state of dialysis patient care. Peer's mission is to improve the quality of dialysis patient care in the United States. Peer's inaugural report addresses 4 topics in dialysis: number and health status of new dialysis patients, hospitalization, mortality, and the 5-Star Quality Rating System for Medicare-certified dialysis facilities. Key findings from the report are: (1) opportunities exist for improved preparation of patients first starting dialysis, as most new dialysis patients initiate with a central venous catheter for vascular access; (2) between 2005 and 2011, hospital admission rates for dialysis patients declined modestly, although rates of admission due primarily to infection did not change; (3) the 30-day readmission rate after live discharge remains elevated relative to the rate for other Medicare beneficiaries; (4) between 2003 and 2011, mortality rates for dialysis patients declined greatly, with a 15% decrease in the first-year mortality rate and a 19% decrease in the per annum mortality rate in prevalent patients; (5) the 5-Star Quality Rating System for dialysis facilities is a simple summary of 7 quality metrics, but its methodology obscures considerable uncertainty about the relative performance of dialysis facilities. Regarding incidence, hospitalization, and mortality, the Peer report demonstrates substantial variation in dialysis patient outcomes across US Census divisions and constituent states. The magnitude of this variation suggests that overarching health of local populations and conditions of the natural and economic environments are important factors in determining outcomes. The report also demonstrates that some outcomes vary seasonally. Specifically, higher rates of complications in wintertime months may be a fruitful target for quality improvement, especially with respect to infection control. Suggested Citation: Weinhandl E, Constantini E, Everson S, et al. Peer Kidney Care Initiative 2014 Report: Dialysis Care and Outcomes in the United States. Am J Kidney Dis. 2015;65(6)(suppl 1):S1-S140. Disclaimer: Except for data regarding the 5-Star Quality Rating System, 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. The Peer Kidney Care Initiative has no affiliation with the US government. Support: The Peer Kidney Care Initiative is supported by grants from 13 dialysis provider organizations: American Renal Associates, Atlantic Dialysis Management Services, Centers for Dialysis Care, DaVita HealthCare Partners, Dialysis Clinic, Inc. (DCI), DSI Renal, Fresenius Medical Care North America, Independent Dialysis Foundation, Northwest Kidney Centers, Renal Ventures Management, Satellite Healthcare, The Rogosin Institute, and US Renal Care. The interpretation and reporting of these data are the responsibility of Chronic Disease Research Group authors, who retain final authority over report content. Financial Disclosure: Mr Weinhandl, Mr Constantini, Dr Everson, Dr Li, and Dr Solid declare that they have no relevant financial interests. Dr Gilbertson has provided consultation to DaVita Clinical Research. Dr Collins is a co-investigator on phase 1 and 2 studies for DaVita Clinical Research. All other authors are employees of their respective dialysis provider organizations.

This 25th US Renal Data System (USRDS) Annual Data Report contains data through 2011, and again examines chronic kidney disease (CKD) in the United States, characterizing its burden in the general population. In the first section, we offer important data on the impact of CKD, and use the CKD staging system as a predictor of morbidity and mortality. We also compare hospitalization and rehospitalization rates and evaluate adverse events and interventions associated with cardiovascular disease. And we continue to report Medicare Part D prescription drug use, acute kidney injury (AKI), and costs associated with CKD.The second section focuses on end-stage renal disease (ESRD). At the end of 2011, 615,899 dialysis and transplant patients were receiving treatment for ESRD—a 3.2% increase from 2010. There were 115,643 new cases of ESRD reported; this was a 1.5% decrease from 2010 and the first decline in actual counts of new ESRD patients over the last 30 years. Total Medicare costs rose 5% in 2011, to $549 billion, while costs for ESRD reached $34.3 billion, accounting for 6.3% of the Medicare budget and an increase of 5.4% from 2010. Data now show similar reductions in mortality rates among patients of all vintages, and there is continued progress in the first year of hemodialysis therapy. Expanded data on rehospitalization after a prior discharge show that 36% of hemodialysis patients are rehospitalized within 30 days of discharge, a number substantially higher than rates found in the general Medicare and CKD populations. Of particular concern are rates of hospitalization for infection in the hemodialysis population, which have increased 43% since 1993. We continue our evaluation of major changes occurring after the start of the bundled Prospective Payment System in January 2011, looking at providers switching to the new system, at pre- and post-bundle changes in the use of erythropoietin, intravenous iron, and vitamin D, and at changes in hemoglobin levels and trends in transfusion events. This 25th US Renal Data System (USRDS) Annual Data Report contains data through 2011, and again examines chronic kidney disease (CKD) in the United States, characterizing its burden in the general population. In the first section, we offer important data on the impact of CKD, and use the CKD staging system as a predictor of morbidity and mortality. We also compare hospitalization and rehospitalization rates and evaluate adverse events and interventions associated with cardiovascular disease. And we continue to report Medicare Part D prescription drug use, acute kidney injury (AKI), and costs associated with CKD. The second section focuses on end-stage renal disease (ESRD). At the end of 2011, 615,899 dialysis and transplant patients were receiving treatment for ESRD—a 3.2% increase from 2010. There were 115,643 new cases of ESRD reported; this was a 1.5% decrease from 2010 and the first decline in actual counts of new ESRD patients over the last 30 years. Total Medicare costs rose 5% in 2011, to $549 billion, while costs for ESRD reached $34.3 billion, accounting for 6.3% of the Medicare budget and an increase of 5.4% from 2010. Data now show similar reductions in mortality rates among patients of all vintages, and there is continued progress in the first year of hemodialysis therapy. Expanded data on rehospitalization after a prior discharge show that 36% of hemodialysis patients are rehospitalized within 30 days of discharge, a number substantially higher than rates found in the general Medicare and CKD populations. Of particular concern are rates of hospitalization for infection in the hemodialysis population, which have increased 43% since 1993. We continue our evaluation of major changes occurring after the start of the bundled Prospective Payment System in January 2011, looking at providers switching to the new system, at pre- and post-bundle changes in the use of erythropoietin, intravenous iron, and vitamin D, and at changes in hemoglobin levels and trends in transfusion events. Support: Funding for the USRDS Coordinating Center is provided under contract to the Minneapolis Medical Research Foundation (MMRF; NIH contract HHSN 267 2007 15002C/NO1-DK-7-5002). Financial Disclosure: Relevant financial interests for contributors to the supplement are listed on page e4.

This 23rd US Renal Data System (USRDS) Annual Data Report covers data through 2009, and again includes a section on chronic kidney disease (CKD) in the United States, defining its burden in the general population. Using NHANES (National Health and Nutrition Examination Survey), Medicare, and employer group health plan data, we look at cardiovascular and other comorbid conditions, adverse events, preventive care, Medicare Part D prescription drug use, and associated costs of CKD to Medicare and employer group health plans. New findings show β-blocker use is 65% among those with congestive heart failure and identified CKD. In those with a history of CKD and an acute myocardial infarction, use is 72%. Angiotensin-converting enzyme inhibitor and angiotensin receptor blockers in those with CKD and congestive heart failure is 47%-57% and 57.4% in the non-CKD population. As in recent years, the second section of the report focuses on end-stage renal disease (ESRD) and the historical data that were the basis of the first USRDS reports. In 2009, 116,395 patients started therapy for ESRD, and the prevalent population reached 571,414 (including 398,861 dialysis patients); 17,736 transplants were performed, and 172,553 patients had a functioning graft at year's end. Program expenditures reached $42.5 billion, with $29.0 billion from Medicare (accounting for 5.9% of total Medicare expenditures, excluding Part D). The incident rate increased 1.1%, to 355.4 per million. At their first outpatient hemodialysis treatment, 65% of patients used only a catheter and 14% began treatment with an arteriovenous fistula. During 2009, 40% of prevalent dialysis patients had a mean monthly hemoglobin level within the previous NKF-KDOQI (National Kidney Foundation's Kidney Disease Outcomes Quality Initiative) target of 11-12 g/dL, and the mean erythropoietin dose per week averaged 18,206 units. First-year mortality declined by 3%, while morbidity among hemodialysis patients continued to be a major issue secondary to increasing rates of hospitalization due to infection. Rehospitalizations are high, with 38% returning within 30 days after a single hospitalization event. The public health effect of kidney disease is larger than previously appreciated, and early detection, education, intervention, and risk factor control need to address the heavy burden of cardiovascular disease and adverse events in this vulnerable population. Suggested Citation: Collins AJ, Foley RN, Chavers B, et al: US Renal Data System 2011 Annual Data Report. Am J Kidney Dis. 2012;59(1)(suppl 1):e1-e420. Publications based upon USRDS data reported here or supplied upon request must include this 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 author(s) and in no way should be seen as an official policy or interpretation of the US government. Support: Funding for the USRDS Coordinating Center is provided under contract to the Minneapolis Medical Research Foundation (MMRF; NIH contract HHSN 267 2007 15002C/NO1-DK-7-5002). Financial Disclosure: Relevant financial interests for contributors to the supplement are listed in the “Funding and Chapter Contributors” page of the supplement. US Renal Data System 2010 Annual Data ReportAmerican Journal of Kidney DiseasesVol. 57Issue 1PreviewThis 22nd US Renal Data System (USRDS) Annual Data Report covers data through 2008 and again includes a volume on chronic kidney disease (CKD) in the United States. Using NHANES (National Health and Nutrition Examination Survey), Medicare, and employer group health plan data, we estimate the relationship between kidney disease markers and mortality risk, examine the likelihood of blood pressure and lipid control by CKD stage, and use International Classification of Diseases, Ninth Revision, Clinical Modification CKD diagnosis codes to report on morbidity, mortality, care, and costs during the transition to end-stage renal disease (ESRD). Full-Text PDF

This 22nd US Renal Data System (USRDS) Annual Data Report covers data through 2008 and again includes a volume on chronic kidney disease (CKD) in the United States. Using NHANES (National Health and Nutrition Examination Survey), Medicare, and employer group health plan data, we estimate the relationship between kidney disease markers and mortality risk, examine the likelihood of blood pressure and lipid control by CKD stage, and use International Classification of Diseases, Ninth Revision, Clinical Modification CKD diagnosis codes to report on morbidity, mortality, care, and costs during the transition to end-stage renal disease (ESRD).

This 21st US Renal Data System (USRDS) Annual Data Report covers data through 2007 and again includes a section on chronic kidney disease (CKD) in the United States. Using National Health and Nutrition Examination Survey and employer group health plan data, we estimate the relationship between kidney disease markers and mortality risk and the likelihood of blood pressure and lipid control by CKD stage; illustrate use of the new International Classification of Diseases, Ninth Revision, Clinical Modification CKD diagnosis codes; and report on morbidity, mortality, care, and costs during the transition to end-stage renal disease (ESRD). New chapters address care of patients with CKD, the transition to ESRD, and acute kidney injury.

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THIS 17TH ANNUAL Data Report reports data through 2003. The US End-Stage Renal Disease Program entered 102,567 patients during 2003 and had 452,957 prevalent patients. Sixteen thousand transplantations were performed, and 128,131 patients had functioning grafts at year end. Incident rates have stabilized and decreased for most groups younger than 60 years. However, rates in younger black patients with diabetes show continued growth in contrast to decreased rates among whites. Care of the dialysis population continues to improve, with 91% of hemodialysis patients reaching treatment targets.