USRDS Releases 2023 Interactive Annual Data Report

The 2023 United States Renal Data System (USRDS) Annual Data Report (ADR) is now available. The report demonstrates the detrimental effects of the COVID-19 pandemic on chronic kidney disease (CKD) and end-stage renal disease (ESRD) and documents racial, ethnic, and socioeconomic treatment and outcome disparities. The data is from medical claims through 2021 and includes some ESRD-related metrics through the first half of 2022.

Highlights from the 2023 USRDS ADR:

• The mortality rate was higher in 2021 than in 2020 for patients with ESRD. The hemodialysis (HD) population was hit particularly hard, to the extent that the prevalent HD population decreased in 2021 for the second year in a row. Overall, COVID-19-related mortality also increased substantially in 2021 for kidney transplant recipients.
• The USRDS examined long COVID for the first time. In the first four months of availability of a new ICD-10-CM code for long COVID (October to December 2021), the incidence of long COVID diagnosis was twice as high among Medicare beneficiaries with CKD as among those without; the incidence was two and a half times as high among beneficiaries treated with dialysis; and over three times as high among kidney transplant recipients.

Other highlights:

• Data on hospitalization and mortality among ESRD patients with Medicare Advantage (MA) coverage is now included.
  Prior to 2021, Medicare fee-for-service (FFS) beneficiaries with CKD were precluded from switching to MA plans, but those with pre-existing MA coverage were allowed to continue it. As a result, the number of ESRD patients with MA coverage was growing at the expected pace. However, with the implementation of the 21st Century Cures Act, all Medicare beneficiaries with ESRD became eligible to enroll in MA plans beginning in the 2021 open enrollment period. As a result, MA enrollment in the prevalent ESRD population remarkably grew by about one-third in 2021 (from 18.3% in 2020 to 24.5% in 2021; ESRD Volume, figure 9.4b). MA spending for ESRD increased by a prodigious 46.4% in a single year (ESRD Volume, figure 9.1), and Medicare FFS spending decreased correspondingly. Future ADRs will track the influence of this shift on Medicare spending for patients with ESRD and should also compare outcomes among those insured under FFS and MA programs.
• Racial, Ethnic, and Socioeconomic Disparities
  Black and Hispanic patients were much less likely to start dialysis at home than White patients; this finding was true across all levels of neighborhood deprivation. However, Black and Hispanic patients were more likely than White patients to remain on home dialysis after one year regardless of neighborhood deprivation.

If you have any questions about the 2023 ADR, please contact USRDS.