Characteristics of patients beginning hemodialysis in the United States on government-funded vs. privately funded health insurance coverage

Purpose. A study of 10,573 patients receiving hemodialysis at Gambro Healthcare facilities over a 3-year period examined the clinical and demographic characteristics of patients at the initiation of hemodialysis. Methods. Data were chosen to reflect the quality of care prior to starting hemodialysis and included the type of vascular access, presence of anemia, evidence of secondary hyperparathyroidism and hyperphosphatemia, and serum albumin levels at the initiation of hemodialysis. Patients were classified according to their type of healthcare insurance-either government-funded (GF) or privately funded (PF). Results. The primary reasons for patients requiring dialysis were consistent across both types of insurance groups. Further only 42.5% of GF and 40. 9% of PF insured patients had a functioning arteriovenous fistula or graft at dialysis initiation. Overall, 53.1% of patients (GF 52%, PF 55%) were severely anemic (hemoglobin 300 pg/ml) was present in both GF (48%) and PF (52%) patients. Fewer GF patients had phosphorus levels exceeding 6.5 mg/dl compared to those with PF insurance (20.8% vs. 29.1%, respectively). Except for serum phosphorus, there were no other significant differences in the laboratory markers. Conclusion. Patients initiating dialysis at Gambro Healthcare had suboptimal clinical and laboratory benchmarks of predialysis care, and these were present irrespective of the type of insurance coverage.