Trends in anemia management in US hemodialysis patients 2004–2010

BMC Nephrology

L Ebony Boulware⁵  Bernard G Jaar⁶  Tariq Shafi⁸  Stephen M Sozio⁸  Julia J Scialla⁴  Deidra C Crews⁸  Patti L Ephraim⁵  Courtney Cook¹  Karen Bandeen-Roche⁷  Navdeep Tangri²  Jing Zhou⁵  Dana C Miskulin³ 

[1] Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA;Division of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada;Tufts Medical Center, 800 Washington St., Boston, MA 02111, USA;Department of Medicine, University of Miami School of Medicine, Miami, FL, USA;Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA;Nephrology Center of Maryland, Baltimore, MD, USA;Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

关键词: Hemodialysis;    Erythropoietin stimulating agents;    Anemia;   

Others  :  1082775
DOI  :  10.1186/1471-2369-14-264

 received in 2013-07-23, accepted in 2013-11-20,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Miskulin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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