ABSTRACT
The Centers for Medicare and Medicaid Services instituted a partially capitated payment system (referred to as “the bundle”) for dialysis services, which included both ESAs and IVI, which were previously separately billable [6]. The recombinant ESA therapies are clearly far more expensive than IV iron products, which accelerated a national trend to use larger cumulative doses of IV iron. Doses of ESA began to decline and IV iron doses began to rise even several months in advance of bundle implementation [7]. The Dialysis Outcomes Practice Patterns study showed mean ferritin increased from 640 to 826 ng/mL from pre-bundle to post bundle (January 2012) and remained stable through December 2013 [8]. The percent of patients with ferritin >1200 ng/mL, which represents a marker of stored iron, increased from 8.6% to 18% of patients [8]. Thus, given the complex and variable pharmacokinetics and biodistribution of these agent, it is necessary to invest in further studies of these agents that are used widespread and administered chronically in the CKD population.
