Limits...
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

a Theoretical target Hb range at T1 and actual Hb levels at baseline, at 18 months, and across all visits. b Theoretical upper target Hb at T2 and actual upper target Hb at baseline
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4555197&req=5

Fig2: a Theoretical target Hb range at T1 and actual Hb levels at baseline, at 18 months, and across all visits. b Theoretical upper target Hb at T2 and actual upper target Hb at baseline

Mentions: Figure 2 depicts for T1 (panel A) and T2 (panel B) the physician-reported (theoretical) target Hb and patients’ Hb levels, stratified by risk groups. Presented for T1 are the theoretical target Hb ranges and actual Hb levels at baseline, at 18 months, and across all visits (with risk factors listed in descending order of the proportion of physicians reporting a theoretical Hb target ≤10.9 g/dL for a given risk factor). As the upper graph in panel A shows, proportionately more physicians endorsed theoretical Hb targets ≤10.9 g/dL for the six risk groups of stroke, elderly, cancer, cardiovascular disease, HTN, and diabetes. In comparison, relatively more physicians reported using theoretical Hb targets ≥11 g/dL in patients without these risk factors. In contrast, patients’ actual Hb levels at baseline, at 18 months, and across all visits were similar across risk groups. Consistently across these three data points, at least 50 % of patients had Hb levels of 11 g/dL or more, and (with a few exceptions) at least 20 % of patients had Hb levels 12 g/dL or higher.Fig. 2


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)

a Theoretical target Hb range at T1 and actual Hb levels at baseline, at 18 months, and across all visits. b Theoretical upper target Hb at T2 and actual upper target Hb at baseline
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: a Theoretical target Hb range at T1 and actual Hb levels at baseline, at 18 months, and across all visits. b Theoretical upper target Hb at T2 and actual upper target Hb at baseline
Mentions: Figure 2 depicts for T1 (panel A) and T2 (panel B) the physician-reported (theoretical) target Hb and patients’ Hb levels, stratified by risk groups. Presented for T1 are the theoretical target Hb ranges and actual Hb levels at baseline, at 18 months, and across all visits (with risk factors listed in descending order of the proportion of physicians reporting a theoretical Hb target ≤10.9 g/dL for a given risk factor). As the upper graph in panel A shows, proportionately more physicians endorsed theoretical Hb targets ≤10.9 g/dL for the six risk groups of stroke, elderly, cancer, cardiovascular disease, HTN, and diabetes. In comparison, relatively more physicians reported using theoretical Hb targets ≥11 g/dL in patients without these risk factors. In contrast, patients’ actual Hb levels at baseline, at 18 months, and across all visits were similar across risk groups. Consistently across these three data points, at least 50 % of patients had Hb levels of 11 g/dL or more, and (with a few exceptions) at least 20 % of patients had Hb levels 12 g/dL or higher.Fig. 2

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