Trends in anemia management in US hemodialysis patients 2004-2010.
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BACKGROUND: There have been major changes in the management of anemia in US hemodialysis patients in recent years. We sought to determine the influence of clinical trial results, safety regulations, and changes in reimbursement policy on practice. METHODS: We examined indicators of anemia management among incident and prevalent hemodialysis patients from a medium-sized dialysis provider over three time periods: (1) 2004 to 2006 (2) 2007 to 2009, and (3) 2010. Trends across the three time periods were compared using generalized estimating equations. RESULTS: Prior to 2007, the median proportion of patients with monthly hemoglobin >12 g/dL for patients on dialysis 0 to 3, 4 to 6 and 7 to 18 months, respectively, was 42%, 55% and 46% declined to 41%, 54%, and 40% after 2007, and declined more sharply in 2010 to 34%, 41%, and 30%. Median weekly Epoeitin alpha doses over the same periods were 18,000, 12,400, and 9,100 units before 2007; remained relatively unchanged from 2007 to 2009; and decreased sharply in the patients 3-6 and 6-18 months on dialysis to 10,200 and 7,800 units, respectively in 2010. Iron doses, serum ferritin, and transferrin saturation levels increased over time with more pronounced increases in 2010. CONCLUSION: Modest changes in anemia management occurred between 2007 and 2009, followed by more dramatic changes in 2010. Studies are needed to examine the effects of declining erythropoietin use and hemoglobin levels and increasing intravenous iron use on quality of life, transplantation rates, infection rates and survival.
Aged, 80 and over
Practice Patterns, Physicians'
Renal Insufficiency, Chronic
Published Version (Please cite this version)10.1186/1471-2369-14-264
Publication InfoBandeen-Roche, K; Boulware, Ebony; Cook, Courtney; Crews, DC; DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators; Ephraim, Patti L; ... Zhou, J (2013). Trends in anemia management in US hemodialysis patients 2004-2010. BMC Nephrol, 14. pp. 264. 10.1186/1471-2369-14-264. Retrieved from http://hdl.handle.net/10161/8329.
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Eleanor Easley Chair in the School of Medicine
Ebony Boulware, MD, MPH is a Professor of Medicine, Chief of the Division of General Internal Medicine in the Department of Medicine, Vice Dean for Translational Science and Associate Vice Chancellor for Translational Research in the School of Medicine at Duke University. She received an A.B. from Vassar College, an M.D. from Duke University, and a M.P.H. from the Johns Hopkins Bloomberg School of Public Health. Dr. Boulware attended medical school at Duke University,