title: Trends in anemia management in US hemodialysis patients 2004-2010.
abstract: BACKGROUND
  There have been major changes in the management of anemia in US hemodialysis patients in recent years. We sought to determine the influence of clinical trial results, safety regulations, and changes in reimbursement policy on practice.
  
  
  METHODS
  We examined indicators of anemia management among incident and prevalent hemodialysis patients from a medium-sized dialysis provider over three time periods: (1) 2004 to 2006 (2) 2007 to 2009, and (3) 2010. Trends across the three time periods were compared using generalized estimating equations.
  
  
  RESULTS
  Prior to 2007, the median proportion of patients with monthly hemoglobin >12 g/dL for patients on dialysis 0 to 3, 4 to 6 and 7 to 18 months, respectively, was 42%, 55% and 46% declined to 41%, 54%, and 40% after 2007, and declined more sharply in 2010 to 34%, 41%, and 30%. Median weekly Epoeitin alpha doses over the same periods were 18,000, 12,400, and 9,100 units before 2007; remained relatively unchanged from 2007 to 2009; and decreased sharply in the patients 3-6 and 6-18 months on dialysis to 10,200 and 7,800 units, respectively in 2010. Iron doses, serum ferritin, and transferrin saturation levels increased over time with more pronounced increases in 2010.
  
  
  CONCLUSIONS
  Modest changes in anemia management occurred between 2007 and 2009, followed by more dramatic changes in 2010. Studies are needed to examine the effects of declining erythropoietin use and hemoglobin levels and increasing intravenous iron use on quality of life, transplantation rates, infection rates and survival.
authors.affiliation: Division of Nephrology, Tufts University School of Medicine, Boston, MA, USA. dmiskulin@tuftsmedicalcenter.org.
authors.forename: Dana C
authors.initials: DC
authors.lastname: Miskulin
authors.forename: Jing
authors.initials: J
authors.lastname: Zhou
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.forename: Karen
authors.initials: K
authors.lastname: Bandeen-Roche
authors.forename: Courtney
authors.initials: C
authors.lastname: Cook
authors.forename: Patti L
authors.initials: PL
authors.lastname: Ephraim
authors.forename: Deidra C
authors.initials: DC
authors.lastname: Crews
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Scialla
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.forename: Tariq
authors.initials: T
authors.lastname: Shafi
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy* / Q000401:mortality*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D055815:Young Adult