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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

Distribution of maximum weekly ESA doses among physicians who responded that they do have an upper limit that should not be exceeded (doses are IU except where noted). ESA erythropoiesis-stimulating agent
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Fig4: Distribution of maximum weekly ESA doses among physicians who responded that they do have an upper limit that should not be exceeded (doses are IU except where noted). ESA erythropoiesis-stimulating agent

Mentions: At T1, 47 % of physicians reported that they did have an upper limit for weekly ESA dose that they would not exceed. At T2, this proportion increased to 74 %. The distribution of these maximum weekly doses is shown in Fig. 4. At T2, more than 40 % of respondents identified an upper limit of 30,000 IU/week or more.Fig. 4


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)

Distribution of maximum weekly ESA doses among physicians who responded that they do have an upper limit that should not be exceeded (doses are IU except where noted). ESA erythropoiesis-stimulating agent
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Distribution of maximum weekly ESA doses among physicians who responded that they do have an upper limit that should not be exceeded (doses are IU except where noted). ESA erythropoiesis-stimulating agent
Mentions: At T1, 47 % of physicians reported that they did have an upper limit for weekly ESA dose that they would not exceed. At T2, this proportion increased to 74 %. The distribution of these maximum weekly doses is shown in Fig. 4. At T2, more than 40 % of respondents identified an upper limit of 30,000 IU/week or more.Fig. 4

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