Should we keep hemoglobin levels as a viable outcome measure?
Identifieur interne : 000156 ( Main/Exploration ); précédent : 000155; suivant : 000157Should we keep hemoglobin levels as a viable outcome measure?
Auteurs : Ajay K. SinghSource :
- Nephrology news & issues [ 0896-1263 ] ; 2010.
Descripteurs français
- KwdFr :
- MESH :
- organisation et administration : Medicare (USA), Mécanismes de remboursement, Réforme des soins de santé.
- économie : Antianémiques, Dialyse rénale.
- Humains, Hémoglobines, États-Unis d'Amérique.
- Wicri :
- geographic : États-Unis.
English descriptors
- KwdEn :
- Health Care Reform (organization & administration), Hematinics (economics), Hemoglobins (drug effects), Humans, Medicare (organization & administration), Outcome Assessment, Health Care (organization & administration), Reimbursement Mechanisms (organization & administration), Renal Dialysis (economics), United States.
- MESH :
- chemical , drug effects : Hemoglobins.
- chemical , economics : Hematinics.
- geographic : United States.
- economics : Renal Dialysis.
- organization & administration : Health Care Reform, Medicare, Outcome Assessment, Health Care, Reimbursement Mechanisms.
- Humans.
Abstract
In conclusion, the most important priority is to shift thinking to ESA dose exposure and away from focusing on the target Hb level. More attention needs to be spent on developing strategies to minimize exposure to high doses of ESAs. Possible strategies might include the subcutaneous administration of ESAs, treating a patient with an elevated ferritin, identifying sources of blood losses, treating infections and/or an inflammatory focus, and the use of computerized protocols. An equally important goal should be to change the CMS QIP anemia measure to a target Hb >9 g/dL. This modification in the QIP anemia measure is supported by the evidence from both the Normal Hematocrit trials and TREAT. If one models the effect of this QIP on the dialysis patient population as a whole, the majority of achieved Hb concentrations will likely be <11 g/dL (similar to the reported findings in the Normal Hematocrit study--see Figure 1). Lastly, translational studies and clinical trials are necessary to test whether exposure to high doses of ESAs explains the higher risk observed in CHOIR, TREAT, and the Normal Hematocrit study.
PubMed: 20364493
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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<front><div type="abstract" xml:lang="en">In conclusion, the most important priority is to shift thinking to ESA dose exposure and away from focusing on the target Hb level. More attention needs to be spent on developing strategies to minimize exposure to high doses of ESAs. Possible strategies might include the subcutaneous administration of ESAs, treating a patient with an elevated ferritin, identifying sources of blood losses, treating infections and/or an inflammatory focus, and the use of computerized protocols. An equally important goal should be to change the CMS QIP anemia measure to a target Hb >9 g/dL. This modification in the QIP anemia measure is supported by the evidence from both the Normal Hematocrit trials and TREAT. If one models the effect of this QIP on the dialysis patient population as a whole, the majority of achieved Hb concentrations will likely be <11 g/dL (similar to the reported findings in the Normal Hematocrit study--see Figure 1). Lastly, translational studies and clinical trials are necessary to test whether exposure to high doses of ESAs explains the higher risk observed in CHOIR, TREAT, and the Normal Hematocrit study.</div>
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<Abstract><AbstractText>In conclusion, the most important priority is to shift thinking to ESA dose exposure and away from focusing on the target Hb level. More attention needs to be spent on developing strategies to minimize exposure to high doses of ESAs. Possible strategies might include the subcutaneous administration of ESAs, treating a patient with an elevated ferritin, identifying sources of blood losses, treating infections and/or an inflammatory focus, and the use of computerized protocols. An equally important goal should be to change the CMS QIP anemia measure to a target Hb >9 g/dL. This modification in the QIP anemia measure is supported by the evidence from both the Normal Hematocrit trials and TREAT. If one models the effect of this QIP on the dialysis patient population as a whole, the majority of achieved Hb concentrations will likely be <11 g/dL (similar to the reported findings in the Normal Hematocrit study--see Figure 1). Lastly, translational studies and clinical trials are necessary to test whether exposure to high doses of ESAs explains the higher risk observed in CHOIR, TREAT, and the Normal Hematocrit study.</AbstractText>
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