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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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Baseline patient haemoglobin levels and subsequent mortality risk. Cox regression models were used to estimate the relationship between the mortality risk and levels of patient Hb either as a continuous variable (inset) or as categories of Hb. Results are based upon data combined from DOPPS phases I, II and III for patients having ESRD >180 days, and were adjusted for age, sex, BMI, years with ESRD, coronary artery disease, congestive heart failure, other cardiovascular disease, cerebrovascular disease, peripheral vascular disease, hypertension, recurrent cellulitis/gangrene, diabetes, lung disease, GI bleed in prior year, neurologic disease, psychiatric disorder, cancer, HIV, single-pool Kt/V, phosphorus, calcium, albumin, study phase and facility clustering effects (n = 5398). Mean study follow-up time was 1.53 years. When limiting the analysis to Hb ≥8 g/dl, the RR was smaller [RR = 0.94 per g/dl higher Hb, P = 0.20 (n = 5091)].
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Figure 5: Baseline patient haemoglobin levels and subsequent mortality risk. Cox regression models were used to estimate the relationship between the mortality risk and levels of patient Hb either as a continuous variable (inset) or as categories of Hb. Results are based upon data combined from DOPPS phases I, II and III for patients having ESRD >180 days, and were adjusted for age, sex, BMI, years with ESRD, coronary artery disease, congestive heart failure, other cardiovascular disease, cerebrovascular disease, peripheral vascular disease, hypertension, recurrent cellulitis/gangrene, diabetes, lung disease, GI bleed in prior year, neurologic disease, psychiatric disorder, cancer, HIV, single-pool Kt/V, phosphorus, calcium, albumin, study phase and facility clustering effects (n = 5398). Mean study follow-up time was 1.53 years. When limiting the analysis to Hb ≥8 g/dl, the RR was smaller [RR = 0.94 per g/dl higher Hb, P = 0.20 (n = 5091)].

Mentions: Crude mortality rates were observed to be higher in patients with lower baseline Hb levels ranging from 10.2% for patients with Hb <8 g/dl to 7.2% with Hb 8–9 g/dl and 5.0%–5.3% for Hb levels >9 g/dl. In multivariate analyses adjusted for numerous patient characteristics and laboratory values, higher baseline Hb levels were associated with a lower overall mortality risk when data from DOPPS I, II and III were combined: the relative risk (RR) of death was 11% lower for every 1 g/dl higher Hb concentration (P = 0.003) when all patient Hb values were considered (Figure 5). Although the mortality risk was consistently seen to be lower for patients with higher Hb levels, mortality risk was especially high for patients with Hb <8 g/dl (RR = 1.78, P = 0.006 versus Hb 11–12 g/dl). For patients with baseline Hb ≥8 g/dl, a 6% lower mortality risk was observed for every 1 g/dl higher Hb (P = 0.20). The mortality risk did not significantly differ for patients with Hb 8–11 g/dl or >12 g/dl compared to patients with Hb 11– 12 g/dl.


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)

Baseline patient haemoglobin levels and subsequent mortality risk. Cox regression models were used to estimate the relationship between the mortality risk and levels of patient Hb either as a continuous variable (inset) or as categories of Hb. Results are based upon data combined from DOPPS phases I, II and III for patients having ESRD >180 days, and were adjusted for age, sex, BMI, years with ESRD, coronary artery disease, congestive heart failure, other cardiovascular disease, cerebrovascular disease, peripheral vascular disease, hypertension, recurrent cellulitis/gangrene, diabetes, lung disease, GI bleed in prior year, neurologic disease, psychiatric disorder, cancer, HIV, single-pool Kt/V, phosphorus, calcium, albumin, study phase and facility clustering effects (n = 5398). Mean study follow-up time was 1.53 years. When limiting the analysis to Hb ≥8 g/dl, the RR was smaller [RR = 0.94 per g/dl higher Hb, P = 0.20 (n = 5091)].
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

Figure 5: Baseline patient haemoglobin levels and subsequent mortality risk. Cox regression models were used to estimate the relationship between the mortality risk and levels of patient Hb either as a continuous variable (inset) or as categories of Hb. Results are based upon data combined from DOPPS phases I, II and III for patients having ESRD >180 days, and were adjusted for age, sex, BMI, years with ESRD, coronary artery disease, congestive heart failure, other cardiovascular disease, cerebrovascular disease, peripheral vascular disease, hypertension, recurrent cellulitis/gangrene, diabetes, lung disease, GI bleed in prior year, neurologic disease, psychiatric disorder, cancer, HIV, single-pool Kt/V, phosphorus, calcium, albumin, study phase and facility clustering effects (n = 5398). Mean study follow-up time was 1.53 years. When limiting the analysis to Hb ≥8 g/dl, the RR was smaller [RR = 0.94 per g/dl higher Hb, P = 0.20 (n = 5091)].
Mentions: Crude mortality rates were observed to be higher in patients with lower baseline Hb levels ranging from 10.2% for patients with Hb <8 g/dl to 7.2% with Hb 8–9 g/dl and 5.0%–5.3% for Hb levels >9 g/dl. In multivariate analyses adjusted for numerous patient characteristics and laboratory values, higher baseline Hb levels were associated with a lower overall mortality risk when data from DOPPS I, II and III were combined: the relative risk (RR) of death was 11% lower for every 1 g/dl higher Hb concentration (P = 0.003) when all patient Hb values were considered (Figure 5). Although the mortality risk was consistently seen to be lower for patients with higher Hb levels, mortality risk was especially high for patients with Hb <8 g/dl (RR = 1.78, P = 0.006 versus Hb 11–12 g/dl). For patients with baseline Hb ≥8 g/dl, a 6% lower mortality risk was observed for every 1 g/dl higher Hb (P = 0.20). The mortality risk did not significantly differ for patients with Hb 8–11 g/dl or >12 g/dl compared to patients with Hb 11– 12 g/dl.

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