International trends in erythropoietin use and hemoglobin levels in hemodialysis patients

被引:64
|
作者
McFarlane, Philip A. [1 ,2 ]
Pisoni, Ronald L. [3 ]
Eichleay, Margaret A. [3 ]
Wald, Ron [2 ,4 ]
Port, Friedrich K. [3 ]
Mendelssohn, David [5 ]
机构
[1] Univ Toronto, Div Nephrol, St Michaels Hosp, Dept Med, Toronto, ON M5C 2T2, Canada
[2] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON M5B 1W8, Canada
[3] Arbor Res Collaborat Hlth, Ann Arbor, MI USA
[4] Univ Toronto, Dept Med, Div Nephrol, Toronto, ON M5C 2T2, Canada
[5] Univ Toronto, Humber River Reg Hosp, Dept Med, Toronto, ON, Canada
关键词
anemia/dt (Drug Therapy); erythropoietin/ad (Administration & Dosage); erythropoietin/ec (Economics); health expenditures/trends; kidney failure; chronic/blood/economics/therapy; reimbursement mechanisms/economics/legislation & jurisprudence; DIALYSIS OUTCOMES; PRACTICE PATTERNS; INTRAVENOUS EPOETIN; DARBEPOETIN-ALPHA; ANEMIA; ASSOCIATION; GUIDELINES; MANAGEMENT; COUNTRIES; MORTALITY;
D O I
10.1038/ki.2010.108
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
Hemoglobin levels and the dose of erythropoiesis-stimulating agents (ESAs) have risen over time in hemodialysis patients within the United States. There are concerns that these trends may be driven by reimbursement policies that provide potential incentives to increase this use. To determine this we studied trends in the use of ESA and hemoglobin levels in hemodialysis patients and the relationship of these trends to the mode of reimbursement. Using the Dialysis Outcomes and Practice Patterns Study (DOPPS) database of hemodialysis we analyzed facility practices in over 300 randomly selected dialysis units in 12 countries. At each of three phases (years 1996-2001, 2002-2004, and 2005-present), we randomly selected over 7500 prevalent hemodialysis, hemofiltration, or hemodiafiltration patients. ESA usage rose significantly in every country studied except Belgium. All but Sweden demonstrated a substantial increase in hemoglobin levels. In 2005 more than 40% of patients had hemoglobin levels above the KDOQI upper target limit of 120 g/l in all but Japan. These trends appeared to be independent of the manner of reimbursement even though the United States is the only country with significant financial incentives promoting increased use of these agents. Thus, our study found that prescribing higher doses of ESAs and achieving higher hemoglobin levels by physicians reflects a broad trend across DOPPS countries regardless of the reimbursement policies. Kidney International (2010) 78, 215-223; doi:10.1038/ki.2010.108; published online 28 April 2010
引用
收藏
页码:215 / 223
页数:9
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