Trends in anemia management in US hemodialysis patients 2004-2010.

Miskulin, Dana C

Zhou, Jing

Tangri, Navdeep

Bandeen-Roche, Karen

Cook, Courtney

Ephraim, Patti L

Crews, Deidra C

Scialla, Julia J

Sozio, Stephen M

Shafi, Tariq

Jaar, Bernard G

Boulware, L Ebony

DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators

England

2014-01-27T03:44:54Z

2013-12-01

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.

http://www.ncbi.nlm.nih.gov/pubmed/24289058

1471-2369-14-264

1471-2369

https://hdl.handle.net/10161/8329

eng

Springer Science and Business Media LLC

BMC Nephrol

10.1186/1471-2369-14-264

Adolescent

Adult

Aged

Aged, 80 and over

Anemia

Causality

Comorbidity

Female

Humans

Incidence

Male

Middle Aged

Practice Patterns, Physicians'

Renal Dialysis

Renal Insufficiency, Chronic

Risk Factors

Survival Rate

United States

Young Adult

Trends in anemia management in US hemodialysis patients 2004-2010.

Journal article

Boulware, L Ebony|0000-0002-8650-4212

http://www.ncbi.nlm.nih.gov/pubmed/24289058

264

Clinical Science Departments

Community and Family Medicine

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, General Internal Medicine

Medicine, Nephrology

School of Medicine

Published online

14