title: Changes in hemoglobin level distribution in US dialysis patients from June 2006 to November 2008.
abstract: BACKGROUND
  Erythropoiesis-stimulating agents (ESAs) have had a positive effect on anemia treatment in dialysis patients. However, several events in recent years, including new clinical study results, ESA product label revisions, and coverage and reimbursement policy changes, have had an impact on ESA dosing patterns and consequently on hemoglobin (Hb) distribution characteristics in this patient population.
  
  
  METHODS
  Retrospective observational study using patient-level data from approximately 87% of dialysis centers in the United States.
  
  
  METHODS
  Dialysis patients who were receiving outpatient care at dialysis facilities during June 2006-November 2008 were included in this study.
  
  
  METHODS
  Recent events affecting ESA treatment practice patterns in US dialysis patients.
  
  
  METHODS
  Hb level distribution.
  
  
  RESULTS
  Mean Hb level decreased by 0.37 g/dL during the indicated period. Additionally, standard deviation (SD) of the Hb level distribution decreased by 0.14 g/dL and skewness increased by -0.10. Hb measurements in specific ranges changed as follows: >12 g/dL, decreased by 11.3 percentage points;10-12 g/dL, increased by 9.4 percentage points; and <10 g/dL, increased by 1.9 percentage points. The percentage of patients with Hb level >13 g/dL for > or =3 months decreased by 2.9 percentage points.
  
  
  CONCLUSIONS
  Potential bias in dialysis center selection and lack of information for patient characteristics.
  
  
  CONCLUSIONS
  Recent events affecting ESA use in dialysis patients have had the desired effect of increasing the proportion of Hb measurements within the US Food and Drug Administration recommended target range of 10-12 g/dL and decreasing the proportion of Hb measurements >12 g/dL. However, the proportion of Hb measurements <10 g/dL also has increased. Benefits of a decrease in Hb measurements in the >12 g/dL range need to be considered, together with risks of having low Hb levels.
authors.affiliation: Health Sciences Center, University of Colorado, Denver, CO, USA. david.spiegel@ucdenver.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Spiegel
authors.forename: Irfan
authors.initials: I
authors.lastname: Khan
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnan
authors.forename: Tracy J
authors.initials: TJ
authors.lastname: Mayne
mesh_terms: D000740:Anemia / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D015995:Prevalence; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D006454:Hemoglobins