Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS)
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DOI：
10.1053/j.ajkd.2004.03.023
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发表时间：
2004-07-01
影响因子：
13.2
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Pisoni, RL;Bragg-Gresham, JL;Port, FK
背景：贫血在血液透析（HD）患者中很常见。方法：从2002年至2003年HD患者的全国代表性样本（n = 11041）收集的数据用于描述目前在12个国家的309个透析单位对长期HD患者的贫血管理。根据人口统计学、15种共病类别、实验室值、国家和设施聚类调整关联分析和结果。结果在透析治疗时间超过180天的患者中，23% - 77%的患者血红蛋白（Hgb）浓度低于11 g/dL (< 110 g/L)，这取决于国家；83% ~ 94%给予促红细胞生成素（EPO）治疗。瑞典平均Hgb水平为12 g/dL (120 g/L)；美国、西班牙、比利时和加拿大为11.6 - 11.7 g/dL (116 - 117 g/L)；澳大利亚/新西兰、德国、意大利、英国和法国的标准为11.1至11.5 g/dL(111至115 g/L)；和10。1 g/dL（日本为101 g/L）。新发终末期肾病患者的Hgb水平明显较低，ESRD前EPO使用率从27%（美国）到65%（瑞典）不等。对患者而言，随着Hgb浓度的增加，EPO的使用显著下降（调整后的优势比为0.61 / 1 g/dL [10 g/L] Hgb浓度增加，P < 0.0001）， EPO剂量也是如此。患者基线Hgb水平每升高1 g/dL，经病例混合调整的死亡率和住院风险分别下降5%和6%（各小于或等于0.003）。此外，设施平均Hgb水平每提高1 g/dL，患者死亡率和住院风险降低10%至12%。如果患者年龄较大，Hgb水平更有可能达到11 g/dL或更高（a:110 g/L）；是男性;患有多囊肾病；有较高的白蛋白、转铁蛋白饱和度或钙水平；我们不用导管进行透析；或者铁蛋白水平较低。静脉铁使用较多的设施显示出较高的设施平均Hgb浓度。EPO的平均剂量从5297（日本）到17360 U/周（美国）不等。较高的国家平均EPO剂量与较高的国家平均Hgb浓度显著相关。一些患者特征与较大的EPO剂量有关。即使在一些静脉铁使用较多的国家，35%至40%的患者转铁蛋白饱和度低于20%（低于指南）。结论：这些研究结果表明，在贫血管理方面存在很大的国际差异，在过去的5年中有了显著的改善，尽管许多患者仍然低于现行的贫血指南，这表明有很大的改善机会。
Background: Anemia is common in hemodialysis (HD) patients. Methods: Data collected from nationally representative samples of HD patients (n = 11,041) in 2002 to 2003 were used to describe current anemia management for long-term HD patients at 309 dialysis units in 12 countries. Analyses of associations and outcomes were adjusted for demographics, 15 comorbid classes, laboratory values, country, and facility clustering. Results For patients on dialysis therapy for longer than 180 days, 23% to 77% had a hemoglobin (Hgb) concentration less than 11 g/dL (< 110 g/L), depending on country; 83% to 94% were administered erythropoietin (EPO). Mean Hgb levels were 12 g/dL (120 g/L) in Sweden; 11.6 to 11.7 g/dL (116 to 117 g/L) in the United States, Spain, Belgium, and Canada; 11.1 to 11.5 g/dL (111 to 115 g/L) in Australia/New Zealand, Germany, Italy, the United Kingdom, and France; and 10. 1 g/dL (101 g/L) in Japan. Hgb levels were substantially lower for new patients with end-stage renal disease, and EPO use before ESRD ranged from 27% (United States) to 65% (Sweden). By patient, EPO use significantly declined with greater Hgb concentration (adjusted odds ratio, 0.61 per 1-g/dL [10-g/L] greater Hgb level; P < 0.0001), as did EPO dosage. Case-mix-adjusted mortality and hospitalization risk declined by 5% and 6% per 1-g/dL greater patient baseline Hgb level (Pless than or equal to 0.003 each), respectively. Furthermore, patient mortality and hospitalization risks were 10% to 12% lower for every 1-g/dL greater facility mean Hgb level. Patients were significantly more likely to have Hgb levels of 11 g/dL or greater (a:110 g/L) if they were older; were men; had polycystic kidney disease; had greater albumin, transferrin saturation, or calcium levels; were not dialyzing with a catheter; or had lower ferritin levels. Facilities with greater intravenous iron use showed significantly greater facility mean Hgb concentrations. Mean EPO dose varied from 5,297 (Japan) to 17,360 U/wk (United States). Greater country mean EPO doses were significantly associated with greater country mean Hgb concentrations. Several patient characteristics were associated with greater EPO doses. Even in some countries with high intravenous iron use, 35% to 40% of patients had a transferrin saturation less than 20% (below guidelines). Conclusion: These findings indicate large international variations in anemia management, with significant improvements during the last 5 years, although many patients remain below current anemia guidelines, suggesting large and specific opportunities for improvement.