Trends in anemia management in US hemodialysis patients 2004-2010

Dana C. Miskulin, Jing Zhou, Navdeep Tangri, Karen Bandeen-Roche, Courtney Cook, Patti L. Ephraim, Deidra C. Crews, Julia J. Scialla, Stephen M. Sozio, Tariq Shafi, Bernard G. Jaar, L. Ebony Boulware

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number264
JournalBMC Nephrology
Volume14
Issue number1
DOIs
StatePublished - Dec 1 2013

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Renal Dialysis
Anemia
Dialysis
Hemoglobins
Iron
Transferrin
Ferritins
Erythropoietin
Survival Rate
Transplantation
Quality of Life
Clinical Trials
Safety
Infection
Serum

Keywords

  • Anemia
  • Erythropoietin stimulating agents
  • Hemodialysis

ASJC Scopus subject areas

  • Nephrology

Cite this

Miskulin, D. C., Zhou, J., Tangri, N., Bandeen-Roche, K., Cook, C., Ephraim, P. L., ... Boulware, L. E. (2013). Trends in anemia management in US hemodialysis patients 2004-2010. BMC Nephrology, 14(1), [264]. https://doi.org/10.1186/1471-2369-14-264

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.

In: BMC Nephrology, Vol. 14, No. 1, 264, 01.12.2013.

Research output: Contribution to journalArticle

Miskulin, DC, Zhou, J, Tangri, N, Bandeen-Roche, K, Cook, C, Ephraim, PL, Crews, DC, Scialla, JJ, Sozio, SM, Shafi, T, Jaar, BG & Boulware, LE 2013, 'Trends in anemia management in US hemodialysis patients 2004-2010', BMC Nephrology, vol. 14, no. 1, 264. https://doi.org/10.1186/1471-2369-14-264
Miskulin DC, Zhou J, Tangri N, Bandeen-Roche K, Cook C, Ephraim PL et al. Trends in anemia management in US hemodialysis patients 2004-2010. BMC Nephrology. 2013 Dec 1;14(1). 264. https://doi.org/10.1186/1471-2369-14-264
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. / Trends in anemia management in US hemodialysis patients 2004-2010. In: BMC Nephrology. 2013 ; Vol. 14, No. 1.
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abstract = "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.",
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AB - 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.

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