(1314) Drastic Drop in Kidney-related Deaths in 2011: What Happened That Year and What Lessons We Learned

Introduction: Kidney-related deaths continue to have high morbidity and mortality (M&M) burden on all healthcare systems across the globe. A review of M&M in the USA showed a similar trend with one exception: In 2011, there was a drastic drop in kidney-related mortality without any rebound in successive years. This abstract reviews the events of that year and determines what lessons can be learned that can be employed in other disease processes.

Methods: As a first step, the authors reviewed and used the tools available on the CDC website to evaluate the age-adjusted death rates for the ten leading causes of death in the USA from 1999-2017. The year 2011 stands out as a unique year across all disease processes, with a drastic drop in kidney-related deaths with no rebound in mortality. A review of related literature also required authors to study publications related to Medicare's Prospective Payment System (PPS). Limitations of the study included the possibility of unknown confounding factors in the year 2011 and a lack of updated data on the CDC website after 2017.

Results: On reviewing the CDC data, the trends in the renal-related age-adjusted death rate were on a steady incline from 13.0 per 100,000 US standard population in 1999 to 15.9 per 100,000 US standard population in 2010. The death rate in 2011 was however, 13.4 per 100,000 US standard population and has stayed consistent over recent years at 13.0 per 100,000 US standard population in 2017. The review of related literature, as described in the 'Methods' section, showed that the drastic decrease in the year 2011 was very closely related to an increase in utilization of peritoneal dialysis (PD) in comparison to the pre-PPS phase. A decrease in overall expenditure and the use of less expensive substitutes for vitamin D products and erythropoietin-stimulating products were also reported thus improving the compliance of patients with ESRD.

Conclusions: This abstract provides an insight into various aspects of clinical care, which can be applied to other disease processes. These include cheaper and generic substitutes and the impact of payment reforms and medical legislation on healthcare utilization and patient mortality. Specifically, to renal causes, it highlights the importance of home-based, patient-self-delivered PD.