%0 Journal Article
%@ 2291-9694
%I JMIR Publications
%V 8
%N 12
%P e18716
%T Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study
%A Hou,Ying-Hui
%A Yang,Feng-Jung
%A Lai,I-Chun
%A Lin,Shih-Pi
%A Wan,Thomas TH
%A Chang,Ray-E
%+ Institute of Health Policy and Management, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Room 639, Taipei, 100, Taiwan, 886 2 3366 8069, rchang@ntu.edu.tw
%K erythropoietin
%K cardiovascular disease
%K peritoneal dialysis
%K diabetes mellitus
%D 2020
%7 17.12.2020
%9 Original Paper
%J JMIR Med Inform
%G English
%X 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. 
%M 33331829
%R 10.2196/18716
%U http://medinform.jmir.org/2020/12/e18716/
%U https://doi.org/10.2196/18716
%U http://www.ncbi.nlm.nih.gov/pubmed/33331829