Clinical factors associated with achieving K/DOQI hemoglobin targets in hemodialysis patients.
BACKGROUND
Few studies have assessed treatable factors associated with achieving the Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline of hemoglobin values of 11 to 12 g/dL in anemic hemodialysis patients.


METHODS
This was a retrospective study of 30,029 prevalent hemodialysis patients with mean hemoglobin values less than 11 g/dL between January 1 and March 31, 1999. We studied the associations between demographic characteristics, comorbid conditions, disease severity, urea reduction ratio, epoetin doses, intravenous iron doses, and mean hemoglobin values in the ensuing 3 months.


RESULTS
Approximately half (51.3%) of patients reached a mean hemoglobin value of at least 11 g/dL. By multiple logistic regression, the major factors showing a positive association with this outcome included a urea reduction ratio greater than 75% (odds ratio [OR], 1.23; P < 0.0001) and intravenous iron (OR: for 0 vials/month, 1; for < 1, 1.22; for 1 to 1.9, 1.36; 2 to 2.9, 1.48; for 3 to 3.9, 1.61; for > or = 4, 1.79; P < 0.0001), while a negative association with hemoglobin response, possibly representing epoetin resistance, was shown for initial severity of anemia (OR: for initial hemoglobin value < 7 g/dL, 0.06; for 7 to 7.9 g/dL, 0.12; for 8 to 8.9 g/dL, 0.23; for 9 to 9.9 g/dL, 0.45; for 10 to 10.9 g/dL, 1; P < 0.0001) and epoetin doses in the highest quintile (OR for > 38,000 units/wk, 0.76; P < 0.0001).


CONCLUSIONS
In patients with persistently low hemoglobin values, optimizing urea clearance and a proactive approach to intravenous iron therapy may enhance epoetin responsiveness.
Li
Suying
S
Nephrology Analytical Services, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA.
Foley
Robert N
RN
Gilbertson
David T
DT
Liu
Jiannong
J
Collins
Allan J
AJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000747:Anemia, Hypochromic / Q000209:etiology / Q000517:prevention & control*; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006454:Hemoglobins / Q000032:analysis / Q000592:standards*; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D011994:Recombinant Proteins; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D017749:Total Quality Management; D016896:Treatment Outcome
D006454:Hemoglobins; D058085:Iron Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin