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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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Epo dosing practices for Epo-treated HD patients in DOPPS III. (A) Distribution of facility mean Epo dose (Epo units/week) among DOPPS III dialysis units. Facility mean Epo dose (units/week) was calculated based on the number of Epo units/week given to Epo-treated patients from a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of DOPPS III; n = 61 facilities. (B) Percentage of Epo-treated HD patients receiving one, two or three Epo doses per week in DOPPS III. Results are based upon a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients. (C) Distribution of patient Epo doses (Epo units/week) in DOPPS III for patients receiving one, two or three Epo doses per week. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients.
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Figure 2: Epo dosing practices for Epo-treated HD patients in DOPPS III. (A) Distribution of facility mean Epo dose (Epo units/week) among DOPPS III dialysis units. Facility mean Epo dose (units/week) was calculated based on the number of Epo units/week given to Epo-treated patients from a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of DOPPS III; n = 61 facilities. (B) Percentage of Epo-treated HD patients receiving one, two or three Epo doses per week in DOPPS III. Results are based upon a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients. (C) Distribution of patient Epo doses (Epo units/week) in DOPPS III for patients receiving one, two or three Epo doses per week. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients.

Mentions: Table 3 shows results on Epo use, IV iron use and iron status. Epo was used by 83% of prevalent HD patients, with 99% of all such patients receiving it intravenously. The average Epo dose given to Japanese prevalent HD patients was 5176 units/week in DOPPS II and 5231 units/week in DOPPS III. However, the facility mean weekly Epo dose varied greatly across DOPPS III dialysis units (Figure 2A): 53% of facilities provided a mean Epo dose <5000 units/week, 24% a mean weekly dose of 5000–5999 units and 23% a mean weekly dose of 6000–9000 units.


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)

Epo dosing practices for Epo-treated HD patients in DOPPS III. (A) Distribution of facility mean Epo dose (Epo units/week) among DOPPS III dialysis units. Facility mean Epo dose (units/week) was calculated based on the number of Epo units/week given to Epo-treated patients from a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of DOPPS III; n = 61 facilities. (B) Percentage of Epo-treated HD patients receiving one, two or three Epo doses per week in DOPPS III. Results are based upon a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients. (C) Distribution of patient Epo doses (Epo units/week) in DOPPS III for patients receiving one, two or three Epo doses per week. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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Show All Figures
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Figure 2: Epo dosing practices for Epo-treated HD patients in DOPPS III. (A) Distribution of facility mean Epo dose (Epo units/week) among DOPPS III dialysis units. Facility mean Epo dose (units/week) was calculated based on the number of Epo units/week given to Epo-treated patients from a point-prevalent cross-section of HD patients having ESRD >180 days in each participating DOPPS dialysis unit at the start of DOPPS III; n = 61 facilities. (B) Percentage of Epo-treated HD patients receiving one, two or three Epo doses per week in DOPPS III. Results are based upon a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients. (C) Distribution of patient Epo doses (Epo units/week) in DOPPS III for patients receiving one, two or three Epo doses per week. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; n = 1412 patients.
Mentions: Table 3 shows results on Epo use, IV iron use and iron status. Epo was used by 83% of prevalent HD patients, with 99% of all such patients receiving it intravenously. The average Epo dose given to Japanese prevalent HD patients was 5176 units/week in DOPPS II and 5231 units/week in DOPPS III. However, the facility mean weekly Epo dose varied greatly across DOPPS III dialysis units (Figure 2A): 53% of facilities provided a mean Epo dose <5000 units/week, 24% a mean weekly dose of 5000–5999 units and 23% a mean weekly dose of 6000–9000 units.

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