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Titolo Protocol adherence and the ability to achieve target haemoglobin levels in haemodialysis patients
Autore Kevin Chan1, John Moran2, Mark Hlatky3 and Richard Lafayette1 - 1Department of Nephrology, 2Satellite Healthcare, Inc, Mountain View, CA and 3Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
Referenza Nephrol Dial Transplant 2009; 24: 1956-1962
Contenuto Abstract Background. Anemia management remains complicated in patients with endstage renal disease on hemodialysis. We wished to evaluate the effect of protocol adherence to EPO and intravenous iron dosing on achieving the desired range of hemoglobin levels. Methods. A cohort of hemodialysis patients was studied to evaluate the rate of adherence to EPO and iron dosing protocols over a 5 month period. A database was completed to evaluate all known comorbidities, demographic factors, and facility issues that might affect hemoglobin levels. A logistic regression model was employed to evaluate the effect of adherence to the anemia protocols on the probability of achieving a hemoglobin level below, within or above the targeted range of 11-12.5g/dl. Results. Among 2114 patients, we found that adherence to both the EPO and iron dosing protocol resulted in the greatest probability of achieving the target hemoglobin range (56 ± 5% in anemia protocol adherent patients versus 42 ± 7% in non adherent patients). This was predominantly due to a lowered risk of having above target haemoglobin levels rather than below. The use of the anemia protocols was associated with lower rates of hospitalization (9 ± 0.7 visits/100 months in adherent group vs 15 ± 2 in non adherent group) and lower utilization of both EPO and intravenous iron. Furthermore, patients in the adherent groups had less variability of their hemoglobin levels month by month, at least as judged by standard deviation. Conclusion. Adherence to anemia protocols, as practiced in the dialysis units included in this cohort, may improve hemodialysis patients? ability to achieve target haemoglobin levels, and by avoiding above target hemoglobin values, lower drug utilization and reduce variability of haemoglobin levels.
Data 29.07.2009
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