title: Anemia management trends in hospital-based dialysis centers (HBDCs), 2010 to 2013.
abstract: BACKGROUND
  Few data have been reported on anemia management practices in hospital-based dialysis centers (HBDCs), which are uniquely different from other freestanding dialysis centers. Examining data from HBDCs would help determine if HBDCs and the general US dialysis population have similar trends related to how anemia is managed in dialysis patients.
  
  
  OBJECTIVE
  Given recent changes in the prescribing information of erythropoiesis-stimulating agents (ESAs) and in end-stage renal disease-related health policy and reimbursement, this study describes trends in anemia management practices in HBDCs from January 2010 through March 2013.
  
  
  METHODS
  Electronic medical records of 5404 adult hemodialysis patients in 50 US-based HBDCs were analyzed retrospectively. Patients included in the study cohort were aged ≥18 years and had at least 1 hemoglobin (Hb) measurement and 1 dose of an ESA between January 2010 and March 2013. End points included Hb concentration, darbepoetin alfa dosing, epoetin alfa dosing, and iron biomarkers (transferrin saturation and ferritin) and dosing.
  
  
  RESULTS
  From 2010 to 2013, mean monthly Hb levels declined from 11.4 to 10.7 g/dL; the percentage of patients with mean monthly Hb levels <10 g/dL increased from 11.3% to 24.4%; and the percentage of patients with mean monthly Hb levels >12 g/dL declined from 30.1% to 11.2%. The median darbepoetin alfa cumulative 4-week dose also declined 38.8%, and the weekly epoetin alfa dose declined 24%. From January 2010 to March 2013, the percentage of patients with transferrin saturation >30% increased from 35.8% to 43.6%, the percentage of patients with ferritin levels >500 ng/mL increased from 62.0% to 77.9%, the percentage of patients with ferritin levels ≥800 ng/mL increased from 28.9% to 47.3%, and the median cumulative 4-week intravenous iron dose increased 50%.
  
  
  CONCLUSIONS
  These study results support growing evidence that meaningful changes have occurred over the last 3 years in how anemia is clinically managed in US hemodialysis patients. Study limitations include that changes in patient clinical/demographic characteristics over time were not controlled for and that study findings may not be applicable to HBDCs that have different patient populations and/or do not use an electronic medical record system. Continuing to evaluate anemia management practices in HBDCs would provide additional information on the risks and benefits of anemia care. Consistent with national data, the findings from this study indicate that from 2010 to 2013, HBDCs modified anemia management practices for dialysis patients, as evidenced by reductions in mean monthly Hb levels and ESA dosing and by increases in iron biomarkers and dosing.
authors.affiliation: Elmhurst Hospital Center-Mt. Sinai School of Medicine, Elmhurst, New York. Electronic address: coritsg@nychhc.org.
authors.forename: George N
authors.initials: GN
authors.lastname: Coritsidis
authors.affiliation: Amgen Inc, Thousand Oaks, California.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Maglinte
authors.affiliation: Nephrology Division at Jacobi Medical Center and North Central Bronx Hospital, New York, New York.
authors.forename: Anjali
authors.initials: A
authors.lastname: Acharya
authors.affiliation: Santa Clara Valley Medical Center and Stanford University, San Jose, California.
authors.forename: Anjali
authors.initials: A
authors.lastname: Saxena
authors.affiliation: IMS Health, Plymouth Meeting, Pennsylvania.
authors.forename: Chun-Lan
authors.initials: CL
authors.lastname: Chang
authors.affiliation: IMS Health, Plymouth Meeting, Pennsylvania.
authors.forename: Jerrold
authors.initials: J
authors.lastname: Hill
authors.affiliation: Amgen Inc, Thousand Oaks, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Gitlin
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lafayette
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy*; D015331:Cohort Studies; D000068256:Darbepoetin alfa / Q000008:administration & dosage; D019468:Disease Management; D000068817:Epoetin Alfa / Q000008:administration & dosage; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis; D006761:Hospitals; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000097:blood; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D007501:Iron
keywords: anemia; erythropoiesis-stimulating agent; hemoglobin; hospital-based dialysis center; iron