Impact of Hemoglobin Measurement and ESA Dose Adjustments in Dialysis
Author Information
Author(s): Irfan Khan, Mahesh Krishnan, Anupam Kothawala, Ashfaq Akhtar
Primary Institution: Amgen Inc.
Hypothesis
The study aims to assess the association of facility-level practice patterns representing hemoglobin measurement and erythropoiesis-stimulating agent (ESA) dose adjustment frequencies with facility-level hemoglobin variation.
Conclusion
Frequent hemoglobin measurements and timely ESA dose adjustments in dialysis patients are associated with lower facility-level hemoglobin variation and an increase in the proportion of patients within ±1 and ±2 g/dL ranges around the facility-level hemoglobin mean.
Supporting Evidence
- More frequent hemoglobin measurement was associated with approximately 7% to 9% gains in the proportion of patients with hemoglobin levels within a ±1 g/dL range around the mean.
- More frequent ESA dose adjustment was associated with approximately 6% to 9% gains in the proportion of patients within the respective hemoglobin ranges.
- The mean facility-level hemoglobin variation decreased from 1.41 g/dL to 1.24 g/dL over the study period.
- The mean facility-level hemoglobin measurement frequency increased from 2.50 to 3.12 per month.
- The mean facility-level ESA dose adjustment frequency increased from 0.76 to 1.01 per month.
Takeaway
If doctors check patients' blood more often and adjust their medicine quickly, patients will have better blood levels.
Methodology
This was a retrospective observational database analysis of patients in dialysis facilities affiliated with large dialysis organizations, covering a follow-up period from July 01, 2006 to June 30, 2009.
Potential Biases
Potential bias due to unmeasured facility-level characteristics and the observational nature of the study.
Limitations
The analysis dataset lacked facility-level demographic characteristics or comorbidity information, and results are limited to patients receiving intravenous epoetin alfa.
Participant Demographics
The study included hemodialysis patients from large dialysis organizations in the United States.
Statistical Information
P-Value
<0.001
Confidence Interval
95% CI for Hb variation ranged from 1.40 to 1.42 g/dL.
Statistical Significance
p<0.001
Digital Object Identifier (DOI)
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