Trends in anemia care in older patients approaching end-stage renal disease in the United States (1995-2010).
Trends in anemia care in older patients approaching end-stage renal disease in the United States (1995-2010).
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DOI：
10.1001/jamainternmed.2014.87
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发表时间：
2014-05
影响因子：
39
通讯作者：
Chertow, Glenn M.
中科院分区：
文献类型：
--
作者：
Winkelmayer, Wolfgang C.;Mitani, Aya A.;Goldstein, Benjamin A.;Brookhart, M. Alan;Chertow, Glenn M.
贫血在晚期慢性肾病患者中很常见。虽然终末期肾病（ESRD）患者的贫血治疗引起了相当大的关注，但对于患者在开始维持性透析或先发性肾移植之前接受的贫血护理的模式和趋势知之甚少。确定接近 ESRD 的 Medicare 受益人接受贫血治疗的趋势。封闭队列研究。美国使用国家 ESRD 登记数据（美国肾脏数据系统）。 1995 年至 2010 年间，466,803 名年龄≥67 岁的患者开始维持性透析或接受先发性肾移植。所有符合条件的患者在 ESRD 前均拥有不间断的医疗保险 (A+B) 保险 (A+B) 超过 2 年。时间，定义为事件 ESRD 的日历年。 ESRD 发生前两年内使用红细胞生成刺激剂 (ESA)、静脉补铁和输血； ESRD 时的血红蛋白浓度。我们使用多变量修正泊松回归来估计调整后的使用流行率 (aPR)，置信区间 (CI) 为 95%。前两年接受任何 ESA 的 ESRD 患者比例从 1995 年的 3.2% 上升到 2007 年的峰值 40.8%；此后，ESA 使用率在 2010 年小幅下降至 35.0%（与 1995 年相比：aPR=9.9；CI：9.0-10.7）。在接受 ESA 的患者中，从首次使用 ESA 到 ESRD 的中位时间从 1995 年的 120 天增加到 2010 年的 337 天。静脉铁剂给药从 1.2% (1995 年) 增加到 12.3% (2010 年；aPR=8.7；CI：7.6-10.1)。接受任何输血的患者比例从 20.6%（1995 年）单调增加至 40.3%（2010 年；aPR=1.88；CI：1.82-1.95）。 1995 年平均血红蛋白浓度为 9.5 g/dL，2006 年增至峰值 10.3 g/dL，然后在 2010 年适度下降至 9.9 g/dL。 1995 年至 2010 年间，接近 ESRD 的老年人越来越有可能接受 ESA 治疗、接受静脉补铁，但也更有可能接受输血。
Anemia is common in patients with advanced chronic kidney disease. While the treatment of anemia in patients with end-stage renal disease (ESRD) has attracted considerable attention, relatively little is known about patterns and trends in the anemia care received by patients before initiating maintenance dialysis or pre-emptive kidney transplantation. To determine the trends in anemia treatment received by Medicare beneficiaries approaching ESRD. Closed cohort study. United States using national ESRD registry data (U.S. Renal Data System). 466,803 patients aged ≥67 years initiated maintenance dialysis or underwent pre-emptive kidney transplantation between 1995 and 2010. All eligible patients had uninterrupted Medicare (A+B) coverage for >2 years before ESRD. Time, defined as calendar year of incident ESRD. Use of erythropoiesis-stimulating agents (ESA), intravenous iron supplements, and blood transfusions in the two years prior to ESRD; hemoglobin concentration at the time of ESRD. We used multivariable modified Poisson regression to estimate adjusted utilization prevalence ratios (aPR) with 95% confidence intervals (CI). The proportion of incident ESRD patients receiving any ESA in the two years before increased from 3.2% in 1995 to a peak of 40.8% in 2007; thereafter, ESA use declined modestly to 35.0% in 2010 (compared with 1995: aPR=9.9; CI: 9.0–10.7). Among patients who received an ESA, median time from first recorded ESA use to ESRD increased from 120 days in 1995 to 337 days in 2010. Intravenous iron administration increased from 1.2% (1995) to 12.3% (2010; aPR=8.7; CI: 7.6–10.1). The proportion of patients receiving any blood transfusions increased monotonically from 20.6% (1995) to 40.3% (2010; aPR=1.88; CI: 1.82–1.95). Mean hemoglobin concentrations were 9.5 g/dL in 1995, increased to a peak of 10.3 g/dL in 2006, and then declined moderately to 9.9 g/dL in 2010. Between 1995 and 2010, older adults approaching ESRD were increasingly more likely to be treated with ESAs, to receive intravenous iron, but also more likely to be transfused.
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DOI：
10.1046/j.1365-2710.2002.00430.x
发表时间：
2002-08-01
影响因子：
2
作者：
Wagner, AK;Soumerai, SB;Ross-Degnan, D
通讯作者：
Ross-Degnan, D
影响因子：
13.2
作者：
Gilbertson, David T.;Monda, Keri L.;Collins, Allan J.
通讯作者：
Collins, Allan J.
影响因子：
39.2
作者：
Carson, Jeffrey L.;Grossman, Brenda J.;Djulbegovic, Benjamin
通讯作者：
Djulbegovic, Benjamin
影响因子：
13.6
作者：
Lefaucheur, Carmen;Loupy, Alexandre;Suberbielle-Boissel, Caroline
通讯作者：
Suberbielle-Boissel, Caroline
影响因子：
158.5
作者：
Pfeffer, Marc A.;Burdmann, Emmanuel A.;Toto, Robert
通讯作者：
Toto, Robert