Epo and nocturnal txs

Gus · August 31, 2006, 6:17pm

In simple basic english, for the sake of some of us home dialysis patients…what the heck does that mean? Is it basicly that we home
patients don’t have restrictions on tha ammount of EPO we use?

Leafsunbear · August 31, 2006, 7:11pm

yeah, does that mean I can get HCT over 36? That will be great news, being that they are talking about cutting my epo back. My HCT was 35.4, but my nurses say they are more interested in my Hemoglobin which is 11.2 now.
LSB

Bill_Peckham · August 31, 2006, 11:07pm

I’d have to read the whole text to be sure but my understanding is that there are finacial withholds by Medicare if a dialyzor’s HCT (Hemoglobin is a better/more accurate measure but Medicare uses hematocrit) goes above 39.

There are all sorts of issues with this - Bell Curves and such - but one predictable result is that units like LSBs will taper EPO at the first hint that it is going up rather than risk a withhold (financial penalty). If I understand the implications of Jim’s post there will not be a withhold if a home dialyzor’s 'crit goes above 39.

However, the is a medical contraindication for a EPO induced 'crit above 39 - I am sure I saw a recent study indicating an increased risk of stroke, and cardiac issues when the hemoglobin is above 13 (which approximates a hematocrit of 39). All this should mean that home dialyzors are given a bit more wiggle room before their EPO is tapered. LSB should have EPO tapered only when her(his?) 'crit is actually trending above 39.

Gus · August 31, 2006, 11:17pm

Bill_Peckham:

I’d have to read the whole text to be sure but my understanding is that there are finacial withholds by Medicare if a dialyzor’s HCT (Hemoglobin is a better/more accurate measure but Medicare uses hematocrit) goes above 39.

There are all sorts of issues with this - Bell Curves and such - but one predictable result is that units like LSBs will taper EPO at the first hint that it is going up rather than risk a withhold (financial penalty). If I understand the implications of Jim’s post there will not be a withhold if a home dialyzor’s 'crit goes above 39.

Why do you think is the reason why home dialyzors are exempt?

However, the is a medical contraindication for a EPO induced 'crit above 39 - I am sure I saw a recent study indicating an increased risk of stroke, and cardiac issues when the hemoglobin is above 13 (which approximates a hematocrit of 39). All this should mean that home dialyzors are given a bit more wiggle room before their EPO is tapered. LSB should have EPO tapered only when her(his?) 'crit is actually trending above 39.