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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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(A) Distribution of facility IV iron use among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The percentage of patients within a facility using IV iron was 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 = 63 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III. (B) Distribution of the number of IV iron doses per month given to prevalent HD patients in DOPPS III. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; analyses were restricted to patients receiving IV iron during the first month after study entry (n = 1336).
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Figure 3: (A) Distribution of facility IV iron use among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The percentage of patients within a facility using IV iron was 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 = 63 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III. (B) Distribution of the number of IV iron doses per month given to prevalent HD patients in DOPPS III. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; analyses were restricted to patients receiving IV iron during the first month after study entry (n = 1336).

Mentions: Intravenous (IV) iron use remained relatively constant in Japan, with 32% and 33% of prevalent HD patients receiving IV iron in 2002 and 2006, respectively (Table 3). However, as shown in Figure 3A, a wide variation is seen across Japanese dialysis units regarding the percentage of patients within a facility receiving IV iron. In 2006, 33% of Japanese dialysis facilities prescribed IV iron to <20% of facility patients during a 4-month period; 29% of facilities prescribed IV iron to ≥50% of patients during the same period.


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 facility IV iron use among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The percentage of patients within a facility using IV iron was 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 = 63 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III. (B) Distribution of the number of IV iron doses per month given to prevalent HD patients in DOPPS III. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; analyses were restricted to patients receiving IV iron during the first month after study entry (n = 1336).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

Figure 3: (A) Distribution of facility IV iron use among Japanese dialysis units in DOPPS I (1999), DOPPS II (2002) and DOPPS III (2006). The percentage of patients within a facility using IV iron was 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 = 63 facilities for DOPPS I, n = 60 for DOPPS II and n = 61 for DOPPS III. (B) Distribution of the number of IV iron doses per month given to prevalent HD patients in DOPPS III. Results are based on a point-prevalent cross-section of Japanese HD patients having ESRD >180 days at the start of DOPPS III; analyses were restricted to patients receiving IV iron during the first month after study entry (n = 1336).
Mentions: Intravenous (IV) iron use remained relatively constant in Japan, with 32% and 33% of prevalent HD patients receiving IV iron in 2002 and 2006, respectively (Table 3). However, as shown in Figure 3A, a wide variation is seen across Japanese dialysis units regarding the percentage of patients within a facility receiving IV iron. In 2006, 33% of Japanese dialysis facilities prescribed IV iron to <20% of facility patients during a 4-month period; 29% of facilities prescribed IV iron to ≥50% of patients during the same period.

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