Abstract
BACKGROUND: Major bleeding is common in dialysis-dependent end-stage kidney disease (ESKD). OBJECTIVES: To compare healthcare resource utilization (HCRU) and costs of major bleeding events between dialysis and non-dialysis populations. METHODS: We identified fee-for-service Medicare beneficiaries aged ≥66 years with a first (index) major bleeding event in 2015-2018. Patients with ESKD receiving in-center hemodialysis (HD) and home dialysis from the US Renal Data System were each compared to patients without ESKD from a 20% Medicare sample. HCRU and cost outcomes were compared using model-based standardization, adjusted for age, sex, and race, during the index major bleeding event and a 1-year follow-up period. RESULTS: Patients receiving in-center HD had index major bleeding hospitalizations that were longer and costlier (adjusted mean differences: 0.7 days [95% CI, 0.6-0.8] and $3.4K [95% CI, $3.2K-$3.7K]) than those without ESKD. During 1-year follow-up, bleeding-related hospitalizations were more common (adjusted rate difference: 37.6 per 100 person-years [95% CI, 35.2-40.1]) and costly (adjusted per-person per-year cost difference: $6.2K [95% CI, $5.8K-$6.7K]) in patients receiving in-center HD than in those without ESKD. Other than blood transfusions, which were more common in home dialysis than in-center HD (adjusted rates per 100 person-years: 255.8 [95% CI, 241.8-269.8] vs 202.1 [95% CI, 199.2-205.0]), HCRU outcomes were generally similar between the dialysis groups. CONCLUSION: Patients receiving dialysis had longer and costlier major bleeding hospitalizations and accrued substantially higher costs after 1 year versus those without ESKD. Readmissions were a key driver of higher HCRU and costs in ESKD.