Pre-emptive replacement of water treatment components improves responsiveness to erythropoiesis-stimulating agents in maintenance haemodialysis patients: a quality improvement report.
Hypo-responsiveness to erythropoiesis-stimulating agents (ESAs) has been associated with increased mortality. We examined the effect of water treatment component replacement on declining ESA responsiveness in the absence of chemical or microbiological standards failure. Pre-emptive renewal of the water treatment system supplying 802 standard-flux haemodialysis patients resulted in a significant rise in haemoglobin from (mean ± SD) 12.1 ± 1.2 to 12.3 ± 1.0 g/dl (p < 0.0001), accompanied by a significant decrease in prescribed dose of darbepoetin alfa from 47.9 ± 27.3 to 44.7 ± 27.6 μg/week (p < 0.0001). ESA responsiveness improved significantly from 0.060 ± 0.041 to 0.055 ± 0.040 μg/kg/g · dl(-1) (p < 0.0001) and the number of patients no longer requiring ESA therapy increased threefold. These benefits were derived in the absence of haemolysis or significant changes in water quality. Renewal of water system components should be conducted even in the absence of proven microbiological and chemical failure.
Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Seema K
SK
Singh
Marina
M
Loucaidou
Albert
A
Power
Simon
S
Beagle
Margaret
M
Nevin
Claire
C
Edwards
Richard
R
Corbett
Damien R
DR
Ashby
Neill
N
Duncan
Peter
P
Choi
D000368:Aged; D003362:Cost-Benefit Analysis; D004920:Erythropoiesis / Q000187:drug effects; D005260:Female; D006397:Hematinics / Q000494:pharmacology / Q000627:therapeutic use*; D015312:Hemodialysis Solutions / Q000737:chemistry* / Q000592:standards*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D006397:Hematinics; D015312:Hemodialysis Solutions