Anemia management of adult hemodialysis patients in the US: Results from the 1997 ESRD Core Indicators Project

Background The Health Care Financing Administration's End-Stage Renal Disea se (ESRD) Core Indicators Project collects clinical information on prevalen t adult patients receiving in-center hemodialysis (HD) care in the United S tales to assess the quality of care delivered. Although hematocrit values, transferrin saturations, and iron prescription practices have improved over the last five years, we sought to determine whether continued opportunitie s for improvement of this domain of care exist. Methods. A random sample of 7292 adult in-center ND patients was selected. Dialysis facility staff provided clinical information for the period of Oct ober through December 1996 for 6558 (94 %) patients; complete laboratory in formation was available from 4991 (73 %) returned forms. Hematocrit values, transferrin saturations, serum ferritin concentrations, epoetin alfa dosin g, and iron prescriptions were abstracted from. patient medical records to assess anemia management practices. Results. The mean hematocrit for this cohort was 32.6 +/- 3.5 %. Seventy-tw o percent of patients had hematocrit values >30 % Forty-two percent had hem atocrit values of 33 to 36 %, and 10 % were severely anemic (hematocrit <28 %). Ninety-four percent of the patients received epoetin alfa intravenousl y (i.v.) and 6 % subcutaneously. The mean weekly dose was 202.4 +/- 137.2 u nits/kg. The mean transferrin saturation was 27.4 +/- 12.6 %; 73 % of patie nts had a mean transferrin saturation greater than or equal to 20 %. The me an serum ferritin concentration was 386 +/- 422 ng/mL; 79 and 12 % of patie nts had a serum ferritin concentration of >100 and >800 ng/mL, respectively . Nine percent of the sample (N = 434) had a transferrin saturation <20% an d serum ferritin concentration <100 ng/mL. Regardless of the patient's tran sferrin saturation, approximately three fourths of the patients received ei ther oral or i.v. iron, and only approximately one half of the patients rec eived i.v. iron. Of the subset of patients with transferrin saturation <20 % and serum ferritin concentration <800 ng/mL, only 53 % were prescribed in travenous iron. Multivariate linear regression analysis revealed that serum albumin, urea reduction ratio, age, and transferrin saturation were signif icantly positively associated with hematocrit. Epoetin alfa dose and serum ferritin concentration were significantly and negatively associated with th e hematocrit (P < 0.001). Conclusion. Although substantial improvements have been made in anemia mana gement for adult in-center PID patients over the past five years, significa nt opportunities persist to improve iron prescription practices.