title: Risk-based individualisation of target haemoglobin in haemodialysis patients with renal anaemia in the post-TREAT era: theoretical attitudes versus actual practice patterns (MONITOR-CKD5 study).
abstract: OBJECTIVE
  Data from an ongoing European pharmacoepidemiological study (MONITOR-CKD5) were used to examine congruence between physician-reported risk-based individualisation of target haemoglobin (Hb) and the actual Hb targets set by these physicians for their patients, as well as actual Hb levels in their patients.
  
  
  METHODS
  Physician investigators participating in the study completed a questionnaire about their anaemia practice patterns and attitudes post-TREAT at the start of the study (T1) and in summer 2013 (T2). These data were compared with the Hb targets identified at baseline for actual patients (n = 1197) enrolled in the study. Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).
  
  
  RESULTS
  At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis. At T1, there was a clear difference in physician-reported (theoretical) target Hb levels for patients across the different risk groups, but there was no difference in patients' actual Hb levels across the risk groups. A similar disparity was noted at T2.
  
  
  CONCLUSIONS
  Physicians' theoretical attitudes to anaemia management in patients on haemodialysis appear to have been influenced by the results of the TREAT study, which involved patients not on dialysis. Physicians claim to use risk-based target Hb levels to guide renal anaemia care. However, there is discrepancy between these declared risk-based target Hb levels and actual target Hb levels for patients with variable risk factors.
authors.affiliation: Università degli Studi di Bari, Bari, Italy.
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Frank
authors.initials: F
authors.lastname: Dellanna
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.forename: Gérard
authors.initials: G
authors.lastname: London
authors.forename: Johannes F
authors.initials: JF
authors.lastname: Mann
authors.forename: Philippe
authors.initials: P
authors.lastname: Zaoui
authors.forename: Matthew
authors.initials: M
authors.lastname: Turner
authors.forename: Mike
authors.initials: M
authors.lastname: Muenzberg
authors.forename: Karen
authors.initials: K
authors.lastname: MacDonald
authors.forename: Ivo
authors.initials: I
authors.lastname: Abraham
mesh_terms: D000328:Adult; D000367:Age Factors; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D001291:Attitude of Health Personnel; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009369:Neoplasms / Q000453:epidemiology*; D010347:Patient Care Planning; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D057285:Precision Medicine; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology
chemical_list: D006397:Hematinics; D006454:Hemoglobins