中国透析患者医疗支出400亿

https://pubmed.ncbi.nlm.nih.gov/31331480/

Forty-billion medical expenditure for dialysis patients in China

To the editor: Thestudy by Wang etal.1 revealed acomprehensive description of the burden of chronic kidney disease and end-stage kidneydisease in China.The study estimated that there were approximately 553,000 hemodialysis patients and 55,000 peritoneal dialysispatients in China in 2015. The median annual overall cost for each peritonealdialysis and hemodialysis patient was 73,266 and 87,125 renminbi, respectively.1According to these data, the total medical expenditure for dialysis patients would have been 40– 50 billion renminbiin 2015, but it was reported as 429 million renminbi.1 As the data of this study are likely to be utilizedby multiple organizations and stakeholders with interests in kidneydisease, it is imperative to note the calculation error.

The authors reply: Weacknowledge the points made by Sepe et al. regarding a potential role for dial- ysis modality in moderating arterialdamage.1 Toclarify, our study was a concept paper,and we clearly statethe limitations regarding the small number of patient samples we were able toutilize.2 The study included 24 children on dialysis, 14 onperitoneal dialysis, and 10 on hemodialysis.The median age was 14.3 years, and the median time on dialysis was 1.9 years,with no significant difference between groups. None of thechildren had underlying inflammatory diseases or infections in the 6 weeks preceding vessel collection. Biocompatible dialysers and ultrapure water for hemodialysis and biocompatiblesolutions for peritoneal dialysis were routinely used. In previous work in a larger cohort of childrenon dialysis, we showed that there was no differencein clinical measuresof vascular calcification (i.e., carotid intima media thickness, pulse wave velocity, or coronary calcification on CT scan)3 or on vessel calcium load4 with respect to dialysis modality. The authors allude to reduced inflammation with vitamin E–coated dialysers, but these dialysers arenot available in pediatric sizes, and there are nostudies that have conclusively shown their benefit inadults on hemodialysis. Regarding the role of immune senescence—in the context of medialvascular calcification in children, in which there arevery few inflammatory cells within the vessel wall, our study highlights a role forsterile inflammation emanating from senescent vascularcells as a novel component of inflammaging.

The authors reply: We thank Tan for the letter discussingthe total medical cost for dialysis patientsin China in 2015.1 The analyses of medical expenditures for dialysis patientswere based on the China Health Insurance Research (CHIRA) database, which is a claimsdatabase that uses a 2-stage sampling design to draw a national sample of beneficiaries covered by urban basic health insurance.2 Altogether, 11,797 eligible dialysis patients were identified in the CHIRA database,as described in our publications.2,3 The total medicalcost of those patientswas 429 million renminbi in 2015,2,3 which is not theoverall cost for dialysis patients in China as suggested by Tan.1 Unfortunately, the information on total medical cost in Chapter 11 of thedata reports2,3 was incomplete, where it should have been made clear that the estimation was related to only the 11,797 dialysispatients in the CHIRA database.

We agree with Tan1 that the medicalexpenditure for dialysis patients in China overall, based on the CHIRA database, is estimated tobe 45 billion renminbi. However, it should be noted that this numberis an underestimate, because there areother types of insurance in China, besidesurban basic health insurance, that are included byCHIRA, such as rural cooperative medical insurance and free medical care. However,due to variation regarding reimbursement policy, as well as accessibility to dialysis treatment, it is hard to estimate the extent of underestimation.