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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

Iron status and iron supplementation by risk group
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Related In: Results  -  Collection


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Fig5: Iron status and iron supplementation by risk group

Mentions: The survey also included questions on iron management practices. At T1, 81 % responded that they did have an upper target for serum ferritin that they would not intentionally exceed. Among these physicians, this upper target was 500 µg/L for 52 %, 750 µg/L for 30 %, and ≥1000 µg/L for 18 %. A shift towards a higher upper target for serum ferritin was noted at T2. At T2, 96 % of physicians replied that they had an upper serum ferritin target; among this group, the upper target was 500 µg/L for 29 %, 750 µg/L for 38 %, and ≥1000 µg/L for 33 %. Actual iron status by risk group is shown in Fig. 5. No significant differences in iron store by risk group pairs (e.g. between those with HTN and those without HTN) were found, except for diabetes; diabetics had a significantly lower rate of adequate iron stores than non-diabetics (65.5 vs. 75.8 %, χ2 = 8.24, p = 0.0162). Iron supplementation by risk group is also shown (Fig. 5); no significant differences in risk group pairs were found.Fig. 5


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)

Iron status and iron supplementation by risk group
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Iron status and iron supplementation by risk group
Mentions: The survey also included questions on iron management practices. At T1, 81 % responded that they did have an upper target for serum ferritin that they would not intentionally exceed. Among these physicians, this upper target was 500 µg/L for 52 %, 750 µg/L for 30 %, and ≥1000 µg/L for 18 %. A shift towards a higher upper target for serum ferritin was noted at T2. At T2, 96 % of physicians replied that they had an upper serum ferritin target; among this group, the upper target was 500 µg/L for 29 %, 750 µg/L for 38 %, and ≥1000 µg/L for 33 %. Actual iron status by risk group is shown in Fig. 5. No significant differences in iron store by risk group pairs (e.g. between those with HTN and those without HTN) were found, except for diabetes; diabetics had a significantly lower rate of adequate iron stores than non-diabetics (65.5 vs. 75.8 %, χ2 = 8.24, p = 0.0162). Iron supplementation by risk group is also shown (Fig. 5); no significant differences in risk group pairs were found.Fig. 5

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