Adequacy of dialysis and differences in hematocrit among dialysis facilities

被引:32
作者
Ifudu, O
Uribarri, J
Rajwani, I
Vlacich, V
Reydel, K
Delosreyes, G
Friedman, EA
机构
[1] SUNY Hlth Sci Ctr, Dept Med, Renal Dis Div, Brooklyn, NY 11203 USA
[2] Nephrol Fdn Brooklyn, Brooklyn, NY USA
[3] Mt Sinai Med Ctr, Dept Med, New York, NY 10029 USA
关键词
erythropoietin (EPO); anemia; adequacy of dialysis; underdialysis; end-stage renal disease (ESRD); hemodialysis (HD); urea reduction ratio (URR); intravenous iron; dialysis facility; End-Stage Renal Disease (ESRD) Network;
D O I
10.1053/ajkd.2000.19830
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Despite the clearly established relationship between adequacy of dialysis and response to erythropoietin, recent guidelines on anemia management in end-stage renal disease (ESRD) omit mention of dialysis adequacy while advocating the use of large amounts of intravenous iron. To determine the relative effects of adequacy of dialysis and intravenous iron on hematocrit, we studied 309 hemodialysis patients and analyzed data from 141 hemodialysis facilities in New York State (ESRD Network 2), as well as data from all 18 ESRD Networks in the United States, for the last quarter of 1997. Among the 309 subjects, mean hematocrit differed between quartiles of urea reduction ratio (URR; F statistic = 4; P = 0.008). Patients with URRs greater than 70% were 2.6 times more likely to have hematocrits greater than 33% (odds ratio, 2.6; 95% confidence interval [CI], 1.3 to 5.3; P = 0.009) after adjustment for other factors. Mean dialysis facility (n = 141) hematocrits correlated directly with mean URRs (r = 0.32; P = 0.001). Facilities with a mean URR greater than 70% were three times more likely to have a mean hematocrit greater than 33% (odds ratio, 3; 95% CI, 1.2 to 7.5; P = 0.02). The percentage of patients in each of the 18 ESRD Networks with hematocrits of 33% or greater correlated inversely with the percentage of patients administered intravenous iron (r = -0.53; P = 0.03) after adjustment for dose of erythropoietin. We conclude that adequacy of dialysis predicts the response to erythropoietin at both patient and dialysis facility levels. Patients with low hematocrits primarily because of inadequate dialysis may inappropriately be administered excess intravenous iron intended as a corrective measure. (C) 2000 by the National Kidney Foundation, Inc.
引用
收藏
页码:1166 / 1174
页数:9
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