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Risk-based individualisation of target haemoglobin in haemodialysis patients with renal anaemia in the post-TREAT era: theoretical attitudes versus actual practice patterns (MONITOR-CKD5 study).

Gesualdo L, Combe C, Covic A, Dellanna F, Goldsmith D, London G, Mann JF, Zaoui P, Turner M, Muenzberg M, MacDonald K, Abraham I - Int Urol Nephrol (2015)

Bottom Line: Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis.A similar disparity was noted at T2.

View Article: PubMed Central - PubMed

Affiliation: Università degli Studi di Bari, Bari, Italy.

ABSTRACT

Purpose: Data from an ongoing European pharmacoepidemiological study (MONITOR-CKD5) were used to examine congruence between physician-reported risk-based individualisation of target haemoglobin (Hb) and the actual Hb targets set by these physicians for their patients, as well as actual Hb levels in their patients.

Methods: Physician investigators participating in the study completed a questionnaire about their anaemia practice patterns and attitudes post-TREAT at the start of the study (T1) and in summer 2013 (T2). These data were compared with the Hb targets identified at baseline for actual patients (n = 1197) enrolled in the study. Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).

Results: At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis. At T1, there was a clear difference in physician-reported (theoretical) target Hb levels for patients across the different risk groups, but there was no difference in patients' actual Hb levels across the risk groups. A similar disparity was noted at T2.

Conclusions: Physicians' theoretical attitudes to anaemia management in patients on haemodialysis appear to have been influenced by the results of the TREAT study, which involved patients not on dialysis. Physicians claim to use risk-based target Hb levels to guide renal anaemia care. However, there is discrepancy between these declared risk-based target Hb levels and actual target Hb levels for patients with variable risk factors.

No MeSH data available.


Related in: MedlinePlus

Centre adoption of clinical practice guidelines for anaemia management in patients with CKD (categories not mutually exclusive). KDIGO Kidney Disease-Improving Global Outcomes, KDOQI Kidney Disease Outcomes Quality Initiative
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Related In: Results  -  Collection


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Fig1: Centre adoption of clinical practice guidelines for anaemia management in patients with CKD (categories not mutually exclusive). KDIGO Kidney Disease-Improving Global Outcomes, KDOQI Kidney Disease Outcomes Quality Initiative

Mentions: Centre and physician characteristics are shown in Table 1. Although fewer centres/physicians participated at T2, the characteristics were similar to those who participated at T1. The different guidelines followed by those physicians questioned are shown in Fig. 1. There was a drop in the proportion of centres adopting the Kidney Disease Outcomes Quality Initiative and European Renal Best Practice guidelines between T1 and T2. At T2, ~80 % of centres had adopted the updated Kidney Disease-Improving Global Outcomes (KDIGO) guidelines (these had not been published at T1). There was a statistically significant shift in the anaemia practice guidelines adopted by centres from T1 to T2 (p < 0.001). At T2, the KDIGO 2007 position statement and 2012 guidelines prevailed, and there was a continued modest adoption of the European Renal Best Practice guidelines. At both T1 and T2, most centres relied on more than one guideline.Table 1


Risk-based individualisation of target haemoglobin in haemodialysis patients with renal anaemia in the post-TREAT era: theoretical attitudes versus actual practice patterns (MONITOR-CKD5 study).

Gesualdo L, Combe C, Covic A, Dellanna F, Goldsmith D, London G, Mann JF, Zaoui P, Turner M, Muenzberg M, MacDonald K, Abraham I - Int Urol Nephrol (2015)

Centre adoption of clinical practice guidelines for anaemia management in patients with CKD (categories not mutually exclusive). KDIGO Kidney Disease-Improving Global Outcomes, KDOQI Kidney Disease Outcomes Quality Initiative
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4555197&req=5

Fig1: Centre adoption of clinical practice guidelines for anaemia management in patients with CKD (categories not mutually exclusive). KDIGO Kidney Disease-Improving Global Outcomes, KDOQI Kidney Disease Outcomes Quality Initiative
Mentions: Centre and physician characteristics are shown in Table 1. Although fewer centres/physicians participated at T2, the characteristics were similar to those who participated at T1. The different guidelines followed by those physicians questioned are shown in Fig. 1. There was a drop in the proportion of centres adopting the Kidney Disease Outcomes Quality Initiative and European Renal Best Practice guidelines between T1 and T2. At T2, ~80 % of centres had adopted the updated Kidney Disease-Improving Global Outcomes (KDIGO) guidelines (these had not been published at T1). There was a statistically significant shift in the anaemia practice guidelines adopted by centres from T1 to T2 (p < 0.001). At T2, the KDIGO 2007 position statement and 2012 guidelines prevailed, and there was a continued modest adoption of the European Renal Best Practice guidelines. At both T1 and T2, most centres relied on more than one guideline.Table 1

Bottom Line: Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis.A similar disparity was noted at T2.

View Article: PubMed Central - PubMed

Affiliation: Università degli Studi di Bari, Bari, Italy.

ABSTRACT

Purpose: Data from an ongoing European pharmacoepidemiological study (MONITOR-CKD5) were used to examine congruence between physician-reported risk-based individualisation of target haemoglobin (Hb) and the actual Hb targets set by these physicians for their patients, as well as actual Hb levels in their patients.

Methods: Physician investigators participating in the study completed a questionnaire about their anaemia practice patterns and attitudes post-TREAT at the start of the study (T1) and in summer 2013 (T2). These data were compared with the Hb targets identified at baseline for actual patients (n = 1197) enrolled in the study. Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).

Results: At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis. At T1, there was a clear difference in physician-reported (theoretical) target Hb levels for patients across the different risk groups, but there was no difference in patients' actual Hb levels across the risk groups. A similar disparity was noted at T2.

Conclusions: Physicians' theoretical attitudes to anaemia management in patients on haemodialysis appear to have been influenced by the results of the TREAT study, which involved patients not on dialysis. Physicians claim to use risk-based target Hb levels to guide renal anaemia care. However, there is discrepancy between these declared risk-based target Hb levels and actual target Hb levels for patients with variable risk factors.

No MeSH data available.


Related in: MedlinePlus