title: Japanese haemodialysis anaemia management practices and outcomes (1999-2006): results from the DOPPS.
abstract: BACKGROUND
  Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients.
  
  
  METHODS
  Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients.
  
  
  RESULTS
  From 1999 to 2006, patient mean Hb increased from 9.7 g/dl to 10.4 g/dl, and the percentage of facilities with median Hb >or=10 g/dl increased from 27% to 75%. Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83% of HD patients; mean Epo dose was 5231 units/week; intravenous (IV) iron use was 33% and median IV iron dose was 160 mg/month. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR = 0.89 per 1 g/dl higher Hb, P = 0.003). Facilities with median Hb >or=10.4 displayed a lower mortality risk (RR = 0.77, P = 0.03) versus facility median Hb <10.4 g/dl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.
  
  
  CONCLUSIONS
  These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.
authors.affiliation: Division of Nephrology, Showa University School of Medicine, Shinagawa, Tokyo 142-8666, Japan. akizawa@med.showa-u.ac.jp
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kurokawa
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control*; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D007564:Japan; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000639:trends*; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012308:Risk Management / Q000639:trends*; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin; D007501:Iron