{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:40:16Z","timestamp":1786372816028,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Calcimimetic drugs used to treat secondary hyperparathyroidism are being considered for inclusion in the Medicare ESRD Prospective Payment System bundle after an evaluation period. Understanding of utilization patterns of calcimimetics across dialysis facilities may help align financial incentives with clinical objectives. Our study\u2019s purpose was to describe the distribution of cinacalcet prescription across United States hemodialysis facilities and to explore factors that may influence cinacalcet utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>We used monthly cross-sectional data from the Dialysis Outcomes and Practice Patterns Study in 2014 to characterize the distribution of cinacalcet prescription across 203 United States hemodialysis facilities (10,521 patients). On the basis of associations with parathyroid hormone levels from patient-level analyses, we used linear mixed-effects regressions to estimate the associations between three facility-level exposures (black race, &lt;65 years old, and having \u22653 years on dialysis [vintage]) and the prevalence of cinacalcet prescription, adjusting for facility- and patient-level potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean percentage of patients in each facility with cinacalcet prescription was 23% in June 2014 (median, 22%; interquartile range, 13%\u201330%). Adjusted for facility-level and nonexposure patient-level variables, the difference in prevalence of cinacalcet prescription between facilities with the highest and lowest quartiles of percentage of black patients was 7.8% (95% confidence interval [95% CI], 0.8% to 14.8%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for trend =0.03). The adjusted prevalence difference was 7.3% for the percentage of patients aged &lt;65 years (95% CI, \u20130.1% to 14.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for trend =0.06) and 11.9% for the percentage of patients with \u22653 years of dialysis (95% CI, 2.4% to 21.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for trend =0.02). These associations changed appreciably, becoming much weaker or even reversing, after further adjusting for the patient-level exposure variables.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Facilities treating more patients who are black, under age 65 years, and having dialysis vintage \u22653 years have higher average levels of cinacalcet prescription. However, these differences were strongly attenuated after accounting for the unbalanced distributions of these patient case-mix variables.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.09550818","type":"journal-article","created":{"date-parts":[[2019,1,21]],"date-time":"2019-01-21T16:11:25Z","timestamp":1548087085000},"page":"241-249","source":"Crossref","is-referenced-by-count":14,"title":["Variability in Cinacalcet Prescription across US Hemodialysis Facilities"],"prefix":"10.2215","volume":"14","author":[{"given":"Douglas S.","family":"Fuller","sequence":"first","affiliation":[{"name":"Arbor Research Collaborative for Health, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Xing","sequence":"additional","affiliation":[{"name":"Global Health Economics, Amgen, Inc., Thousand Oaks, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasily","family":"Belozeroff","sequence":"additional","affiliation":[{"name":"Global Health Economics, Amgen, Inc., Thousand Oaks, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alon","family":"Yehoshua","sequence":"additional","affiliation":[{"name":"Global Health Economics, Amgen, Inc., Thousand Oaks, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hal","family":"Morgenstern","sequence":"additional","affiliation":[{"name":"Departments ofEpidemiology and"},{"name":"Environmental Health Sciences, School of Public Health, and"},{"name":"Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce M.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Arbor Research Collaborative for Health, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Rubin","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Georgetown University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Global Health Economics, Amgen, Inc., Thousand Oaks, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald L.","family":"Pisoni","sequence":"additional","affiliation":[{"name":"Arbor Research Collaborative for Health, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,1,21]]},"reference":[{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1053\/j.ajkd.2009.12.005","article-title":"The 2009 proposed rule for prospective ESRD payment: Historical perspectives and public policies--bundle up!","volume":"55","author":"Weiner","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1053\/j.ajkd.2009.12.004","article-title":"The 2009 proposed rule for prospective ESRD payment: Perspectives from a large dialysis organization.","volume":"55","author":"Nissenson","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1053\/j.ajkd.2009.12.009","article-title":"The 2009 proposed rule for prospective ESRD payment: Perspectives from a for-profit small dialysis organization.","volume":"55","author":"Bhat","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1056\/NEJMoa031633","article-title":"Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis.","volume":"350","author":"Block","year":"2004","journal-title":"N Engl J 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disorder (CKD-MBD).","volume":"7","year":"2017","journal-title":"Kidney Int Suppl"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1159\/000350213","article-title":"Evaluating real-world use of cinacalcet and biochemical response to therapy in US hemodialysis patients.","volume":"37","author":"Kilpatrick","year":"2013","journal-title":"Am J Nephrol"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1159\/000353298","article-title":"Racial differences in clinical use of cinacalcet in a large population of hemodialysis patients.","volume":"38","author":"Newsome","year":"2013","journal-title":"Am J Nephrol"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"354","DOI":"10.2215\/CJN.05241008","article-title":"Cinacalcet use patterns and effect on laboratory values and other medications in a large dialysis organization, 2004 through 2006.","volume":"4","author":"St Peter","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"issue":"Suppl 74","key":"B19-20230813","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.1046\/j.1523-1755.2000.07413.x","article-title":"The Dialysis Outcomes and Practice Patterns Study (DOPPS): An international hemodialysis study.","volume":"57","author":"Young","year":"2000","journal-title":"Kidney Int"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1053\/j.ajkd.2004.03.023","article-title":"Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS).","volume":"44","author":"Pisoni","year":"2004","journal-title":"Am J Kidney Dis"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1053\/j.ajkd.2011.03.001","article-title":"The Dialysis Outcomes and Practice Patterns Study (DOPPS) practice monitor: Rationale and methods for an initiative to monitor the new US bundled dialysis payment system.","volume":"57","author":"Robinson","year":"2011","journal-title":"Am J Kidney Dis"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1053\/j.jrn.2004.05.001","article-title":"Age-related decline in serum parathyroid hormone in maintenance hemodialysis patients is independent of inflammation and dietary nutrient intake.","volume":"14","author":"Mehrotra","year":"2004","journal-title":"J Ren Nutr"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1093\/ndt\/gfv034","article-title":"Refining the definition of clinically important mineral and bone disorder in hemodialysis patients.","volume":"30","author":"Danese","year":"2015","journal-title":"Nephrol Dial Transplant"},{"key":"B26-20230813","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1053\/j.ajkd.2010.08.006","article-title":"Using race as a case-mix adjustment factor in a renal dialysis payment system: Potential and pitfalls.","volume":"56","author":"Roach","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B28-20230813","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1681\/ASN.V112330","article-title":"Race is a major determinant of secondary hyperparathyroidism in uremic patients.","volume":"11","author":"Gupta","year":"2000","journal-title":"J Am Soc Nephrol"},{"key":"B29-20230813","doi-asserted-by":"crossref","first-page":"312","DOI":"10.5414\/CNP70312","article-title":"Race is a major determinant of secondary hyperparathyroidism in uremic patients: Comparative study of Blacks and Hispanics.","volume":"70","author":"Omije","year":"2008","journal-title":"Clin Nephrol"},{"key":"B30-20230813","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1053\/j.ajkd.2011.11.005","article-title":"The DOPPS practice monitor for US dialysis care: Trends through April 2011.","volume":"59","author":"Robinson","year":"2012","journal-title":"Am J Kidney 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