Original Investigations: Dialysis TherapiesEffect of Variability in Anemia Management on Hemoglobin Outcomes in ESRD
Section snippets
Methods
The study population was derived from all patients undergoing dialysis in FMCNA facilities in the United States for the period January 1 through December 31, 2000. For the first phase of the study, all FMCNA patients with more than a single Hgb value from January 1 to March 31, 2000 (first quarter [Q1], 2000), were included. All samples for laboratory values were drawn predialysis for patients on hemodialysis therapy. General characteristics of the population were determined regarding age,
Phase I: defining Hgb level distribution and tracking effects of EPO and/or iron therapy
Sixty-five thousand nine patients contributed data in the phase I cohort of the study. Population demographics are listed in Table 1.Ninety-three percent of patients were on hemodialysis therapy, and the remainder were on peritoneal dialysis therapy. Ninety-eight percent of patients were on EPO therapy, and 48% were on intravenous iron therapy. The 3-month rolling average Hgb level distribution for Q1 of 2000 is shown in Fig 1.
Discussion
We show that Hgb level variability in individual patients causes a substantial portion of dialysis patients (28%) to move both above and below the target Hgb level range during a relatively short period of follow-up. One component of this Hgb level variability is related to population or interpatient variability. This population variability is not unique to Hgb values because biological variability with a Gaussian distribution is found with nearly all laboratory measurements. In the case of Hgb
References (63)
- et al.
Working capacity is increased following recombinant human erythropoietin treatment
Kidney Int
(1988) - et al.
The impact of recombinant human erythropoietin on exercise capacity in hemodialysis patients
Adv Ren Replace Ther
(1994) - et al.
Improvement of brain function in hemodialysis patients treated with erythropoietin
Kidney Int
(1990) - et al.
rHuEPO treatment improves brain and cognitive function of anemic dialysis patients
Kidney Int
(1991) - et al.
Trends in anemia treatment with erythropoietin usage and patient outcomes
Am J Kidney Dis
(1998) - et al.
Hematocrit levels and associated Medicare expenditures
Am J Kidney Dis
(2000) Optimal hematocrit in patients on dialysis
Am J Kidney Dis
(1998)- et al.
Prospective evaluation of an anemia treatment algorithm in hemodialysis
Am J Kidney Dis
(1998) Separate hemoglobin standards for blacks and whites: A critical review of the case for and unequal hemoglobin standards
Med Hypotheses
(1990)- et al.
C-Reactive protein as an outcome predictor for maintenance hemodialysis patients
Kidney Int
(1998)
Iron replacement in rHuEPO-treated dialysis patients: DOQI and beyond
Am J Kidney Dis
Clinical utility of the reticulocyte hemoglobin content in the diagnosis of iron deficiency
Blood
A randomized trial of iron deficiency testing strategies in hemodialysis patients
Kidney Int
Novel erythropoiesis stimulating protein for treatment of anemia in chronic renal insufficiency
Kidney Int
Treatment of the anemia of progressive renal failure with recombinant human erythropoietin
N Engl J Med
Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving hemodialysis
BMJ
Subjective quality of life assessment in hemodialysis patients at different levels of hemoglobin following the use of recombinant human erythropoietin
Am J Nephrol
Quality of life and hematocrit level
Am J Kidney Dis
The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patients
J Am Soc Nephrol
Increasing the hematocrit has a beneficial effect on quality of life and is safe in selected hemodialysis patients. Spanish Cooperative Renal Patients Quality of Life Study Group of the Spanish Society of Nephrology
J Am Soc Nephrol
Long-term cardiorespiratory effects of amelioration of renal anaemia by erythropoietin
Lancet
Exercise in hemodialysis patients after treatment with recombinant human erythropoietin
Nephron
Recombinant erythropoietin improves cognitive function in patients maintained on ambulatory peritoneal dialysis
Nephrol Dial Transplant
Effect of normalization of hematocrit on brain circulation and metabolism in hemodialysis patients
J Am Soc Nephrol
Improved sexual function in hemodialysis patients on recombinant erythropoietin: A possible role for prolactin
Clin Nephrol
Improved sexual function during recombinant human erythropoietin therapy
Nephrol Dial Transplant
Influence of erythropoietin treatment on gonadotropic hormone levels and sexual function in male uremic patients
Scand J Urol Nephrol
Impact of recombinant human erythropoietin treatment on left ventricular hypertrophy and cardiac function in dialysis patients
Blood Purif
Morphologic and functional changes of left ventricle in dialyzed patients after treatment with recombinant human erythropoietin (r-HuEPO)
Angiology
The CREATE trial—Building the evidence
Nephrol Dial Transplant
DOQI Clinical Practice Guidelines for the Treatment of Anemia of Chronic Renal Failure
Am J Kidney Dis
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2014, Computer Methods and Programs in BiomedicineThe anaemia control model: Does it help nephrologists in therapeutic decision-making in the management of anaemia?
2018, NefrologiaCitation Excerpt :Although controversial, the variability of Hb has been associated to worse clinical outcomes, mainly in haemodialysis patients.15,18–20 Currently there are doubts about the definition of variability of Hg levels, their quantification,18,19,21–23 the causes involved and the clinical significance.24–30 Additional important problems in this scenario are dose regimens and resistance to ESAs.
Address reprint requests to Eduardo Lacson, Jr, MD, Fresenius Medical Care, North America, 95 Hayden Ave, Lexington, MA 02420. E-mail: [email protected]
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