Dialysis Facility Ownership and Epoetin Dosing in Patients Receiving Hemodialysis

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Abstract
Anemia is a common complication of chronic kidney disease and end-stage renal disease (ESRD).1,2 The introduction of recombinant human erythropoietin (rHuEPO; EPOGEN [epoetin alfa]) in 1989 significantly improved the clinical management of anemia of ESRD.3 By 2005, 99% of in-center hemodialysis patients received epoetin treatment for their anemia.4 Epoetin dosing has changed dramatically in the past decade and a half; between 1991 and 2005, the mean dose of epoetin increased about 4-fold in dialysis patients.5 Today, epoetin therapy is the largest single Medicare drug expenditure totaling $1.8 billion in 2004 (an increase of 17% from 2003) and epoetin comprised 11% of all Medicare ESRD costs.4