Japanese haemodialysis anaemia management practices and outcomes (19992006): results from the DOPPS
Identifieur interne : 001302 ( Istex/Corpus ); précédent : 001301; suivant : 001303Japanese haemodialysis anaemia management practices and outcomes (19992006): results from the DOPPS
Auteurs : Tadao Akizawa ; Ronald L. Pisoni ; Takashi Akiba ; Akira Saito ; Shunichi Fukuhara ; Yasushi Asano ; Takeshi Hasegawa ; Friedrich K. Port ; Kiyoshi KurokawaSource :
- Nephrology Dialysis Transplantation [ 0931-0509 ] ; 2008-11.
Abstract
Background. Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients. Methods. Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients. Results. From 1999 to 2006, patient mean Hb increased from 9.7 gdl to 10.4 gdl, and the percentage of facilities with median Hb 10 gdl increased from 27 to 75. Hb was measured in the supine position for 90 of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83 of HD patients; mean Epo dose was 5231 unitsweek; intravenous (IV) iron use was 33 and median IV iron dose was 160 mgmonth. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR 0.89 per 1 gdl higher Hb, P 0.003). Facilities with median Hb 10.4 displayed a lower mortality risk (RR 0.77, P 0.03) versus facility median Hb <10.4 gdl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores. Conclusions. These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.
Url:
DOI: 10.1093/ndt/gfn346
Links to Exploration step
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<affiliation><mods:affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</mods:affiliation>
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<affiliation><mods:affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</mods:affiliation>
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<affiliation><mods:affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</mods:affiliation>
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<affiliation><mods:affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</mods:affiliation>
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<front><div type="abstract">Background. Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients. Methods. Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients. Results. From 1999 to 2006, patient mean Hb increased from 9.7 gdl to 10.4 gdl, and the percentage of facilities with median Hb 10 gdl increased from 27 to 75. Hb was measured in the supine position for 90 of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83 of HD patients; mean Epo dose was 5231 unitsweek; intravenous (IV) iron use was 33 and median IV iron dose was 160 mgmonth. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR 0.89 per 1 gdl higher Hb, P 0.003). Facilities with median Hb 10.4 displayed a lower mortality risk (RR 0.77, P 0.03) versus facility median Hb <10.4 gdl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores. Conclusions. These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.</div>
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<abstract>Background. Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients. Methods. Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients. Results. From 1999 to 2006, patient mean Hb increased from 9.7 gdl to 10.4 gdl, and the percentage of facilities with median Hb 10 gdl increased from 27 to 75. Hb was measured in the supine position for 90 of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83 of HD patients; mean Epo dose was 5231 unitsweek; intravenous (IV) iron use was 33 and median IV iron dose was 160 mgmonth. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR 0.89 per 1 gdl higher Hb, P 0.003). Facilities with median Hb 10.4 displayed a lower mortality risk (RR 0.77, P 0.03) versus facility median Hb >10.4 gdl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores. Conclusions. These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.</abstract>
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<author xml:id="author-3"><persName><forename type="first">Takashi</forename>
<surname>Akiba</surname>
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<affiliation>Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo</affiliation>
<affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</affiliation>
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<author xml:id="author-4"><persName><forename type="first">Akira</forename>
<surname>Saito</surname>
</persName>
<affiliation>Department of Internal Medicine and Institute of Medical Science, Tokai University School of Medicine, Isehara, Kanagawa</affiliation>
<affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</affiliation>
</author>
<author xml:id="author-5"><persName><forename type="first">Shunichi</forename>
<surname>Fukuhara</surname>
</persName>
<affiliation>Department of Epidemiology and Healthcare Research, Graduate School of Medicine, Kyoto University, Kyoto</affiliation>
<affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</affiliation>
</author>
<author xml:id="author-6"><persName><forename type="first">Yasushi</forename>
<surname>Asano</surname>
</persName>
<affiliation>Department of Internal Medicine, Jichi Medical School and Koga Red Cross Hospital, Ibaragi</affiliation>
<affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</affiliation>
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<author xml:id="author-7"><persName><forename type="first">Takeshi</forename>
<surname>Hasegawa</surname>
</persName>
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<author xml:id="author-8"><persName><forename type="first">Friedrich K.</forename>
<surname>Port</surname>
</persName>
<affiliation>Arbor Research Collaborative for Health, Ann Arbor, MI, USA</affiliation>
<affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</affiliation>
</author>
<author xml:id="author-9"><persName><forename type="first">Kiyoshi</forename>
<surname>Kurokawa</surname>
</persName>
<affiliation>The Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan</affiliation>
<affiliation>Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: 81-3-3784-8686; Fax: 81-3-3784-3751;</affiliation>
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<monogr><title level="j">Nephrology Dialysis Transplantation</title>
<title level="j" type="abbrev">Nephrol Dial Transplant</title>
<idno type="pISSN">0931-0509</idno>
<idno type="eISSN">1460-2385</idno>
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<abstract><p>Background. Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients. Methods. Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients. Results. From 1999 to 2006, patient mean Hb increased from 9.7 gdl to 10.4 gdl, and the percentage of facilities with median Hb 10 gdl increased from 27 to 75. Hb was measured in the supine position for 90 of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83 of HD patients; mean Epo dose was 5231 unitsweek; intravenous (IV) iron use was 33 and median IV iron dose was 160 mgmonth. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR 0.89 per 1 gdl higher Hb, P 0.003). Facilities with median Hb 10.4 displayed a lower mortality risk (RR 0.77, P 0.03) versus facility median Hb <10.4 gdl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores. Conclusions. These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.</p>
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<item><term>DOPPS</term>
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<abbrev-journal-title abbrev-type="pubmed">Nephrol Dial Transplant</abbrev-journal-title>
<issn pub-type="ppub">0931-0509</issn>
<issn pub-type="epub">1460-2385</issn>
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<title-group><article-title>Japanese haemodialysis anaemia management practices and outcomes (1999–2006): results from the DOPPS</article-title>
<alt-title alt-title-type="left-running">T. Akizawa <italic>et al</italic>
.</alt-title>
<alt-title alt-title-type="right-running">Anaemia and outcomes in Japanese HD patients: DOPPS</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Akizawa</surname>
<given-names>Tadao</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Pisoni</surname>
<given-names>Ronald L.</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Akiba</surname>
<given-names>Takashi</given-names>
</name>
<xref ref-type="aff" rid="af3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Saito</surname>
<given-names>Akira</given-names>
</name>
<xref ref-type="aff" rid="af4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fukuhara</surname>
<given-names>Shunichi</given-names>
</name>
<xref ref-type="aff" rid="af5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Asano</surname>
<given-names>Yasushi</given-names>
</name>
<xref ref-type="aff" rid="af6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hasegawa</surname>
<given-names>Takeshi</given-names>
</name>
<xref ref-type="aff" rid="af5 af7">5,7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Port</surname>
<given-names>Friedrich K.</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kurokawa</surname>
<given-names>Kiyoshi</given-names>
</name>
<xref ref-type="aff" rid="af8">8</xref>
</contrib>
</contrib-group>
<aff id="af1"><label>1</label>
<addr-line>Division of Nephrology</addr-line>
, <institution>Showa University School of Medicine</institution>
, <addr-line>Tokyo</addr-line>
, <country>Japan</country>
</aff>
<aff id="af2"><label>2</label>
<addr-line>Arbor Research Collaborative for Health, Ann Arbor, MI</addr-line>
, <country>USA</country>
</aff>
<aff id="af3"><label>3</label>
<addr-line>Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo</addr-line>
<institution>Women's Medical University</institution>
, <addr-line>Tokyo</addr-line>
</aff>
<aff id="af4"><label>4</label>
<addr-line>Department of Internal Medicine and Institute of Medical Science</addr-line>
, <institution>Tokai University School of Medicine</institution>
, <addr-line>Isehara, Kanagawa</addr-line>
</aff>
<aff id="af5"><label>5</label>
<addr-line>Department of Epidemiology and Healthcare Research, Graduate School of Medicine</addr-line>
, <institution>Kyoto University</institution>
, <addr-line>Kyoto</addr-line>
</aff>
<aff id="af6"><label>6</label>
<addr-line>Department of Internal Medicine, Jichi Medical School and Koga Red Cross Hospital, Ibaragi</addr-line>
</aff>
<aff id="af7"><label>7</label>
<addr-line>Division of Nephrology, Department of Internal Medicine</addr-line>
, <institution>Showa University Fujigaoka Hospital</institution>
, <addr-line>Yokohama</addr-line>
</aff>
<aff id="af8"><label>8</label>
<addr-line>The Research Center for Advanced Science and Technology</addr-line>
, <institution>University of Tokyo</institution>
, <addr-line>Tokyo</addr-line>
, <country>Japan</country>
</aff>
<author-notes><corresp><italic>Correspondence and offprint requests to</italic>
: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: <phone>+81-3-3784-8686</phone>
; Fax: <fax>+81-3-3784-3751</fax>
; E-mail: <email>akizawa@med.showa-u.ac.jp</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>11</month>
<year>2008</year>
</pub-date>
<pub-date pub-type="epub"><day>24</day>
<month>6</month>
<year>2008</year>
</pub-date>
<volume>23</volume>
<issue>11</issue>
<fpage>3643</fpage>
<lpage>3653</lpage>
<history><date date-type="received"><day>3</day>
<month>7</month>
<year>2007</year>
</date>
<date date-type="accepted"><day>26</day>
<month>5</month>
<year>2008</year>
</date>
</history>
<permissions><copyright-statement>© The Author [2008].</copyright-statement>
<copyright-year>2008</copyright-year>
<copyright-holder>Oxford University Press</copyright-holder>
<license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/uk/"><p>The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org</p>
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<abstract><p><bold>Background.</bold>
Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients.</p>
<p><bold>Methods.</bold>
Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients.</p>
<p><bold>Results.</bold>
From 1999 to 2006, patient mean Hb increased from 9.7 g/dl to 10.4 g/dl, and the percentage of facilities with median Hb ≥10 g/dl increased from 27% to 75%. Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83% of HD patients; mean Epo dose was 5231 units/week; intravenous (IV) iron use was 33% and median IV iron dose was 160 mg/month. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR = 0.89 per 1 g/dl higher Hb, <italic>P</italic>
= 0.003). Facilities with median Hb ≥10.4 displayed a lower mortality risk (RR = 0.77, <italic>P</italic>
= 0.03) versus facility median Hb <10.4 g/dl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.</p>
<p><bold>Conclusions.</bold>
These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.</p>
</abstract>
<kwd-group><title>Keywords</title>
<kwd>anaemia</kwd>
<kwd>DOPPS</kwd>
<kwd>hospitalization</kwd>
<kwd>mortality</kwd>
<kwd>quality of life</kwd>
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<affiliation>Division of Nephrology, Showa University School of Medicine, Tokyo, Japan</affiliation>
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<abstract>Background. Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients. Methods. Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients. Results. From 1999 to 2006, patient mean Hb increased from 9.7 gdl to 10.4 gdl, and the percentage of facilities with median Hb 10 gdl increased from 27 to 75. Hb was measured in the supine position for 90 of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83 of HD patients; mean Epo dose was 5231 unitsweek; intravenous (IV) iron use was 33 and median IV iron dose was 160 mgmonth. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR 0.89 per 1 gdl higher Hb, P 0.003). Facilities with median Hb 10.4 displayed a lower mortality risk (RR 0.77, P 0.03) versus facility median Hb <10.4 gdl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores. Conclusions. These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.</abstract>
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