For-profit dialysis more aggressive on anemia drugs

By Kim Dixon

CHICAGO (Reuters) - For-profit dialysis chains treating the bulk of kidney disease patients in the United States are more aggressive in using lucrative anemia drugs, compared with their nonprofit peers, a study released on Tuesday said.

The Journal of the American Medical Association study compared prescribing patterns at nonprofits versus big corporate chains and found doctors at chains give patients bigger increases and total doses of epoetin.

Epoetin boosts oxygen-transporting hemoglobin in red blood cells of kidney disease patients, who are prone to low red blood cell counts.

The anemia medication, a man-made version of the natural protein erythropoietin, is sold by Amgen Inc. as Epogen. Medicare, the health insurance plan for 43 million elderly and disabled in the United States, spends about $1.8 billion on epoetin, its biggest single drug expense.

The JAMA report comes on top of recent findings that higher-than-recommended doses boost the risk of death and serious heart problems. U.S. regulators last month ordered a "black box" warning on the drugs, highlighting these risks and advising doctors to use the lowest effective dose.

"What surprised us the most is how certain chains and providers clearly were targeting (red blood cell levels) outside the U.S. Food and Drug Administration label," Mae Thamer, the lead author on the paper and researcher at the Medical Technology and Practice Patterns Institute in Bethesda, Maryland, said.

The recommended levels at the time of the study were to keep patients' blood comprised of between 33 percent and 36 percent of red blood cells, known as the hematocrit level.

The recommended levels have since increased, but experts last week proposed dropping them again amid the safety concerns.