National perspective on iron therapy as a clinical performance measure formaintenance hemodialysis patients

The Health Care Financing Administration (HCFA) End-Stage Renal Disease (ES RD) Core Indicators Project collects clinical information on prevalent adul t patients receiving in-center hemodialysis care in the United States to as sess the quality of care delivered. Although hematocrit values, transferrin saturations (TSATs) and iron prescription practices have improved over the last 5 years, we sought to determine whether there are continued opportuni ties for improvement of this domain of care. A random sample of 7,292 adult in-center hemodialysis patients was selected for the period October throug h December 1996. Hematocrit values, TSATs, serum ferritin concentrations, e poetin-alfa dosing, and iron prescriptions were abstracted from 4,991 patie nt medical records to assess anemia management practices. The mean hematocr it for this cohort was 32.6% +/- 3.5%, and 72% of patients had hematocrit v alues greater than 30%. Ninety-four percent of patients received epoetin al fa intravenously, with a mean weekly epoetin dose of 202.4 +/- 137.2 U/kg. The mean TSAT was 27.4% +/- 12.6%; 73% of patients had TSATs greater than o r equal to 20%. The mean serum ferritin concentration was 386 +/- 422 ng/mL ; 79% and 12% of patients had serum ferritin concentrations greater than 10 0 ng/mL and greater than 800 ng/mL, respectively. Nine percent of the sampl e had TSATs less than 20% and serum ferritin concentrations less than 100 n g/mL. Regardless of the TSAT, approximately three fourths of patients recei ved iron; only about half received IV iron. Of the subset of patients with TSATs less than 20% and serum ferritin concentration less than 800 ng/mL, o nly 53% were prescribed IV iron. Although substantial improvements have bee n made in anemia management in hemodialysis patients over the last 5 years, significant opportunities persist to improve iron prescription practices. (C) 1999 by the National Kidney Foundation, Inc.