Vascular access choices for dialysis patients, MBD treatments differ in U.S. and Canada

Most dialysis patients in Canada are prescribed vitamin D analogs orally, while most U.S. dialysis patients are given it intravenously. However, since a practice change in one large U.S. dialysis provider, 34% of treated U.S. patients are now using oral calcitriol alone or in addition to IV vitamin D. Researchers from the U.S. and Canada will make comparisons of outcomes among dialysis patients from both countries at the upcoming Dialysis Outcomes and Practice Patterns Study Practice Monitor web conference on Thursday, May 18. Register for free here.

Canadian practices also have a 4-fold lower use of cinacalcet (close to 7% of the Canadian dialysis population), compared to U.S. practices. High serum levels of PTH remain common, however, as 23% of U.S. patients (February 2017) and 30% of Canadian patients (April 2015) have PTH levels above the upper limit of roughly 600 pg/ml suggested by international (KDIGO) guidelines. These percentages in Canada and the U.S. are among the highest across all countries in the DOPPS.

In Canada, vascular access is nearly evenly split between use of arteriovenous fistula and catheter, with catheter use in Canada among the highest in DOPPS countries at 51%. The reasons for the practice differences, and implications, will be discussed by the presenters.

Use and dosing patterns of erythropoiesis-stimulating agents (ESA) in the U.S. have changed significantly between 2010 and 2013, with sustained reductions in weekly IV epoetin doses of 35-40% among treated patients during that time. Following that decline, weekly dose levels in the United States have been nearly equivalent to those in Canada, where dosing levels have remained stable for at least five years.