@Article{info:doi/10.2196/18716,
author="Hou, Ying-Hui
and Yang, Feng-Jung
and Lai, I-Chun
and Lin, Shih-Pi
and Wan, Thomas TH
and Chang, Ray-E",
title="Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study",
journal="JMIR Med Inform",
year="2020",
month="Dec",
day="17",
volume="8",
number="12",
pages="e18716",
keywords="erythropoietin; cardiovascular disease; peritoneal dialysis; diabetes mellitus",
abstract="Background: The change in the reimbursement policy of erythropoietin administration to patients receiving peritoneal dialysis by the Taiwan National Health Insurance (NHI) system provided a natural experimental venue to examine whether cardiovascular risk differs when maintaining the hematocrit (Hct) level below or above 30{\%}. Objective: The aim of this study was to analyze the impact of loosening the erythropoietin payment criteria for peritoneal dialysis patients on their cardiovascular outcomes. Methods: Two cohorts of incident peritoneal dialysis patients were identified according to the time before and after relaxation of the NHI's erythropoietin payment criteria, designated cohort 1 (n=1759) and cohort 2 (n=2981), respectively. The cohorts were matched according to propensity scores (1754 patients in each cohort) and then followed up for cardiovascular events, which were analyzed with Cox regressions. Results: For the composite cardiovascular endpoint, patients in cohort 2 had a significantly lower risk than those in cohort 1. However, subgroup analysis showed that this risk reduction was observed only in patients with diabetes. Conclusions: After loosening erythropoietin payment criteria, reduced cardiovascular risks were observed, particularly for patients with diabetes. These results indicate that it is crucial to maintain an Hct level above 30{\%} to reduce the cardiovascular risk in patients with diabetes undergoing peritoneal dialysis. ",
issn="2291-9694",
doi="10.2196/18716",
url="http://medinform.jmir.org/2020/12/e18716/",
url="https://doi.org/10.2196/18716",
url="http://www.ncbi.nlm.nih.gov/pubmed/33331829"
}