title: Should measuring haemoglobin among chronic kidney disease patients be a performance measure?
abstract: OBJECTIVE
  We attempted to: (1) to assess whether or not adequate evidence exists to advocate the measurement of anaemia in chronic kidney disease as a performance measure; and (2) to determine what the appropriate benchmarks might be for health systems seeking to implement this performance measure.
  
  
  METHODS
  Our study was conducted in two phases: (1) we used the United States Preventive Service Task Force chain of evidence methodology to determine six key questions that were subsequently reviewed to determine if adequate evidence existed to recommend haemoglobin testing among patients with chronic kidney disease; and (2) in order to establish a benchmark for a potential performance measure we measured the number of patients who had a test for anaemia during the preceding year and during the preceding three years. We established these benchmarks using chronic kidney disease defined both by estimated glomerular filtration rate and ICD-9 codes.
  
  
  METHODS
  Benchmarking was undertaken at Kaiser Permanente Northwest, which serves the Portland, Oregon and Vancouver, Washington metropolitan area, and Kaiser Permanente Georgia, which serves the Atlanta metropolitan area.
  
  
  METHODS
  Patients with chronic kidney disease identified by either estimated glomerular filtration rate or ICD-9 code. MAIN OUTCOMES MEASUREMENT: Serum haemoglobin
  
  
  METHODS
  This was an observational study.
  
  
  RESULTS
  Our review of the evidence found no direct evidence that testing for anaemia among patients with chronic kidney disease improved patient morbidity or mortality. The ideal test for anaemia was serum haemoglobin. We found that available treatments of anaemia improve fatigue, but may increase mortality and stoke. We also found that an overwhelming majority of patients with chronic kidney disease defined by either estimated glomerular filtration rate or ICD-9 codes, over one or three years had had a haemoglobin measurement.
  
  
  CONCLUSIONS
  There is currently inadequate evidence to recommend haemoglobin measurement among patients with chronic kidney disease as a performance measure. In addition, most patients with chronic kidney disease have already had haemoglobin measurement, minimizing the potential benefit of a performance measure.
authors.affiliation: Department of Nephrology, Kaiser Permanente Northwest, Portland, OR 97215, USA. micahthorp@comcast.net
authors.forename: Micah L
authors.initials: ML
authors.lastname: Thorp
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Eric S
authors.initials: ES
authors.lastname: Johnson
authors.forename: Jessica W
authors.initials: JW
authors.lastname: Weiss
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Petrik
authors.forename: Xiu Hai
authors.initials: XH
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019985:Benchmarking / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D014481:United States
chemical_list: D015415:Biomarkers; D006454:Hemoglobins