Crash Dialysis Trends Show Potential Areas for Medicare Quality and Cost Improvement

Ping Chen
,
Rouguia Barry
,
Yoshio N. Hall

Chronic kidney disease (CKD) affects approximately 36 million adults, or about 14% of the U.S. adult population, and contributes substantially to morbidity and mortality. The worst outcomes for patients with kidney failure occur among those who "crash into dialysis," as opposed to those patients who start dialysis in a planned manner.

The COVID-19 pandemic, which further complicated health care access, potentially increased rates of unplanned dialysis initiation due to disruptions in health care services and delayed diagnoses. However, the impact of the COVID-19 pandemic on patients crashing into dialysis remains unknown. Understanding the impact of the pandemic will help to determine intermediate- and long-term consequences the health care system may face from unplanned dialysis and inform strategies to mitigate future episodes of health care interruptions and shutdowns.

This research brief presents a methodological approach to estimate the proportion of patients who crash into dialysis and provides empirical estimates using 2018–2022 trends from a 5% random sample of Medicare fee-for-service beneficiaries. The primary goal of this research is to establish a claims-based measure that accurately captures crash dialysis—a costly and morbid condition that warrants additional research—and illustrate the measure’s use in studying the temporal association of COVID-19 on unplanned dialysis.
 

Key Findings 

  • More than 125,000 Americans annually develop end-stage renal disease, or kidney failure, and need dialysis or a transplant to stay alive. The worst outcomes for patients with kidney failure occur among those who initiate dialysis in an unplanned manner—commonly known as crashing into dialysis.
  • Approximately one in three fee-for-service Medicare beneficiaries with kidney failure crashed into dialysis during 2018–2022 based on a new measure developed by AIR. During the COVID-19 pandemic, a higher incidence of crash starts and increased deaths after crash dialysis occurred. 
  • Consistent screening for chronic kidney disease, especially for people with diabetes and hypertension, would likely reduce the need for crash dialysis and lead to savings for Medicare, reduced deaths, and improved quality of life for beneficiaries.