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Japanese haemodialysis anaemia management practices and outcomes (1999-2006): results from the DOPPS.

Akizawa T, Pisoni RL, Akiba T, Saito A, Fukuhara S, Asano Y, Hasegawa T, Port FK, Kurokawa K - Nephrol. Dial. Transplant. (2008)

Bottom Line: Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries.Many patient- and facility-level factors were significantly related to higher Hb.Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan. akizawa@med.showa-u.ac.jp

ABSTRACT

Background: Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients.

Methods: Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients.

Results: From 1999 to 2006, patient mean Hb increased from 9.7 g/dl to 10.4 g/dl, and the percentage of facilities with median Hb >or=10 g/dl increased from 27% to 75%. Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83% of HD patients; mean Epo dose was 5231 units/week; intravenous (IV) iron use was 33% and median IV iron dose was 160 mg/month. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR = 0.89 per 1 g/dl higher Hb, P = 0.003). Facilities with median Hb >or=10.4 displayed a lower mortality risk (RR = 0.77, P = 0.03) versus facility median Hb <10.4 g/dl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.

Conclusions: These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.

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Related in: MedlinePlus

(A) Distribution of haemoglobin concentrations among prevalent Japanese haemodialysis patients with ESRD >180 days in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The results for each study phase are based upon a point-prevalent cross-section of HD patients with ESRD >180 days in DOPPS I (n = 1996), DOPPS II (n = 1581) or DOPPS III (n = 1656). The standard deviation ranged from 1.35 in DOPPS I to 1.23–1.26 in DOPPS II and III. (B) Distribution of facility median haemoglobin concentrations among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002), and DOPPS III (2006). Facility median haemoglobin concentrations were determined for a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of each study phase; n = 64 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III.
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Figure 1: (A) Distribution of haemoglobin concentrations among prevalent Japanese haemodialysis patients with ESRD >180 days in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The results for each study phase are based upon a point-prevalent cross-section of HD patients with ESRD >180 days in DOPPS I (n = 1996), DOPPS II (n = 1581) or DOPPS III (n = 1656). The standard deviation ranged from 1.35 in DOPPS I to 1.23–1.26 in DOPPS II and III. (B) Distribution of facility median haemoglobin concentrations among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002), and DOPPS III (2006). Facility median haemoglobin concentrations were determined for a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of each study phase; n = 64 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III.

Mentions: The distribution of Hb concentrations was determined for a prevalent cross-section of HD patients having chronic renal failure >180 days at the beginning of each DOPPS phase. As shown in Figure 1A, a substantial shift to higher Hb levels occurred over the period: The mean patient Hb concentration rose from 9.7 g/dl in 1999 to 10.4 g/dl in 2006 (P < 0.0001). The percentage of Japanese HD patients with Hb ≥10 g/dl increased from 40% in 1999 to 65% in 2006. Older HD patients were found to have considerably lower mean Hb concentrations in DOPPS III, with patients of age 18–44 having mean Hb of 10.73 g/dl compared with 10.58, 10.32 and 10.15 for patients aged 45–60, 61–75 and >75 years, respectively. Although significantly higher mean Hb levels were observed among younger Japanese HD patients, Epo use was significantly greater among older Japanese HD patients, ranging from 77 to 78% Epo use in patients 18– 60 years old versus 85% in 61–75 years old and 88% in patients >75 years old. No significant differences in weekly Epo dose or IV iron use were seen across these age groups.


Japanese haemodialysis anaemia management practices and outcomes (1999-2006): results from the DOPPS.

Akizawa T, Pisoni RL, Akiba T, Saito A, Fukuhara S, Asano Y, Hasegawa T, Port FK, Kurokawa K - Nephrol. Dial. Transplant. (2008)

(A) Distribution of haemoglobin concentrations among prevalent Japanese haemodialysis patients with ESRD >180 days in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The results for each study phase are based upon a point-prevalent cross-section of HD patients with ESRD >180 days in DOPPS I (n = 1996), DOPPS II (n = 1581) or DOPPS III (n = 1656). The standard deviation ranged from 1.35 in DOPPS I to 1.23–1.26 in DOPPS II and III. (B) Distribution of facility median haemoglobin concentrations among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002), and DOPPS III (2006). Facility median haemoglobin concentrations were determined for a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of each study phase; n = 64 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2568010&req=5

Figure 1: (A) Distribution of haemoglobin concentrations among prevalent Japanese haemodialysis patients with ESRD >180 days in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The results for each study phase are based upon a point-prevalent cross-section of HD patients with ESRD >180 days in DOPPS I (n = 1996), DOPPS II (n = 1581) or DOPPS III (n = 1656). The standard deviation ranged from 1.35 in DOPPS I to 1.23–1.26 in DOPPS II and III. (B) Distribution of facility median haemoglobin concentrations among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002), and DOPPS III (2006). Facility median haemoglobin concentrations were determined for a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of each study phase; n = 64 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III.
Mentions: The distribution of Hb concentrations was determined for a prevalent cross-section of HD patients having chronic renal failure >180 days at the beginning of each DOPPS phase. As shown in Figure 1A, a substantial shift to higher Hb levels occurred over the period: The mean patient Hb concentration rose from 9.7 g/dl in 1999 to 10.4 g/dl in 2006 (P < 0.0001). The percentage of Japanese HD patients with Hb ≥10 g/dl increased from 40% in 1999 to 65% in 2006. Older HD patients were found to have considerably lower mean Hb concentrations in DOPPS III, with patients of age 18–44 having mean Hb of 10.73 g/dl compared with 10.58, 10.32 and 10.15 for patients aged 45–60, 61–75 and >75 years, respectively. Although significantly higher mean Hb levels were observed among younger Japanese HD patients, Epo use was significantly greater among older Japanese HD patients, ranging from 77 to 78% Epo use in patients 18– 60 years old versus 85% in 61–75 years old and 88% in patients >75 years old. No significant differences in weekly Epo dose or IV iron use were seen across these age groups.

Bottom Line: Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries.Many patient- and facility-level factors were significantly related to higher Hb.Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan. akizawa@med.showa-u.ac.jp

ABSTRACT

Background: Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients.

Methods: Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients.

Results: From 1999 to 2006, patient mean Hb increased from 9.7 g/dl to 10.4 g/dl, and the percentage of facilities with median Hb >or=10 g/dl increased from 27% to 75%. Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83% of HD patients; mean Epo dose was 5231 units/week; intravenous (IV) iron use was 33% and median IV iron dose was 160 mg/month. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR = 0.89 per 1 g/dl higher Hb, P = 0.003). Facilities with median Hb >or=10.4 displayed a lower mortality risk (RR = 0.77, P = 0.03) versus facility median Hb <10.4 g/dl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.

Conclusions: These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.

Show MeSH
Related in: MedlinePlus