In patients age 66 & older at dialysis initiation.
The Medical Evidence Report notably includes item 17, “Comorbid Conditions,” with a single instruction to the attending physician: “Check all that apply currently and/or during the last 10 years.” According to data from the report, the prevalence of most comorbid conditions among incident ESRD patients initiating on dialysis in freestanding facilities changed very little between 2006 and 2011. The prevalence of hypertension and other cardiac disease (presumably, valvular diseases and arrhythmias) has increased modestly, as has the prevalence of patients needing assistance with daily activities. The prevalence of insulin-treated diabetes has also increased, but has been offset by decreased prevalence of oral medication-treated diabetes.
These data ultimately suggest that concurrent decreases in rates of death and hospitalization during the first year after dialysis initiation are unlikely to be attributable to increasingly healthier cohorts of incident cases.
Prevalence of Comorbid Conditions, According to the Medical Evidence Report
Despite widespread use of comorbidity designations on the Medical Evidence (ME) Report, there are serious questions about the validity of the designations. For elderly patients with at least six months of Medicare coverage before initiating dialysis, it is feasible to carefully compare comorbid designations from Medicare claims and the ME form. These comparisons indicate widespread disagreement between the sources. The prevalence of congestive heart failure, atherosclerotic heart disease, cerebrovascular accident, peripheral vascular disease, chronic obstructive pulmonary disease, and tobacco use are all higher in claims than in data from the ME form. And in large minorities of patients, designations of comorbid conditions on the ME form are not substantiated by claims with corresponding diagnosis codes. These data cast considerable doubt on the validity of standardized outcomes measures.