Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS).
BACKGROUND
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study based on data collected from nationally representative samples of haemodialysis facilities. The burden of anaemia in haemodialysis patients is substantial, leading to considerable morbidity, mortality and reduced quality of life. This study examines anaemia management and outcomes based on data from five European countries participating in the DOPPS: France, Germany, Italy, Spain and the UK.


METHODS
Baseline data on demographics, co-morbidities and anaemia management in 4591 haemodialysis patients from 101 nephrology facilities were collected in 1998-2000. Using multivariate Cox survival analyses to adjust for patient characteristics, relationships between haemoglobin concentration at study entry and rates of mortality and hospitalization were evaluated.


RESULTS
For a year 2000 sample of prevalent patients on haemodialysis >180 days, mean haemoglobin concentration was 11.0 g/dl; 53% had a haemoglobin concentration > or = 11 g/dl [1998-1999 = 44% (P < 0.05)]. In 2000, 84% of prevalent patients were prescribed recombinant human erythropoietin (rHuEpo). Higher haemoglobin concentrations were associated with decreased relative risk (RR) for mortality (RR = 0.95 for every 1 g/dl higher haemoglobin, P = 0.03) and hospitalization (RR = 0.96, P = 0.02). Patients with haemoglobin <10 g/dl were 29% more likely to be hospitalized than patients with haemoglobin 11-12 g/dl (P < 0.001).


CONCLUSIONS
Even after adjustment, lower haemoglobin concentrations were associated with higher morbidity and mortality in European haemodialysis patients. A trend to increased haemoglobin concentrations was observed following publication of the European Best Practice Guidelines (EBPG) on anaemia management for chronic kidney disease patients, but efforts must continue to achieve EBPG goals.
Locatelli
Francesco
F
Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy.
Pisoni
Ronald L
RL
Combe
Christian
C
Bommer
Juergen
J
Andreucci
Vittorio E
VE
Piera
Luis
L
Greenwood
Roger
R
Feldman
Harold I
HI
Port
Friedrich K
FK
Held
Philip J
PJ
D000740:Anemia / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D003430:Cross-Sectional Studies; D004921:Erythropoietin / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000706:statistics & numerical data; D016896:Treatment Outcome
D006397:Hematinics; D058085:Iron Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin