TY  - JOUR
AU  - Hou, Ying-Hui
AU  - Yang, Feng-Jung
AU  - Lai, I-Chun
AU  - Lin, Shih-Pi
AU  - Wan, Thomas TH
AU  - Chang, Ray-E
PY  - 2020
DA  - 2020/12/17
TI  - Effects of Erythropoietin Payment Policy on Cardiovascular Outcomes of Peritoneal Dialysis Patients: Observational Study
JO  - JMIR Med Inform
SP  - e18716
VL  - 8
IS  - 12
KW  - erythropoietin
KW  - cardiovascular disease
KW  - peritoneal dialysis
KW  - diabetes mellitus
AB  - 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. 
SN  - 2291-9694
UR  - http://medinform.jmir.org/2020/12/e18716/
UR  - https://doi.org/10.2196/18716
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33331829
DO  - 10.2196/18716
ID  - info:doi/10.2196/18716
ER  -