title: Trends in anemia management practices in patients receiving hemodialysis and peritoneal dialysis: a retrospective cohort analysis.
abstract: OBJECTIVE
  Recent changes in clinical practice guidelines and reimbursement policies may have affected the use of anemia-related medications and red blood cell (RBC) transfusions in peritoneal dialysis (PD) and hemodialysis (HD) patients. We sought to compare patterns of erythropoiesis-stimulating agents (ESA) and intravenous (IV) iron use, achieved hemoglobin levels, and RBC transfusion use in PD and HD patients.
  
  
  METHODS
  In quarterly cohorts of prevalent dialysis patients receiving persistent therapy (>3 months), 2007-2011, with Medicare Parts A and B coverage, we assessed ESA and IV iron use and dose, RBC transfusions, and hemoglobin levels. Quarterly transfusion rates were calculated.
  
  
  RESULTS
  Observable PD and HD patients numbered 14,958 and 221,866 in Q1/2007 and 17,842 and 256,942 in Q4/2011. Adjusted ESA use was lower in PD (71.4-80.1%) than in HD (86.9-92.0%) patients, decreasing from 80.1% (Q1/2010) to 71.4% (Q4/2011) in PD patients, and from 92.0 to 86.9% in HD patients. The mean adjusted ESA dose decreased by 67.5% in PD and 58.4% in HD patients. IV iron use tended to increase, peaking at 39.3% for PD (Q3/2011) and 80.5% for HD (Q2/2011) patients. Adjusted mean hemoglobin levels fell from 11.7 to 10.6 mg/dl in PD and from 12.0 to 10.7 mg/dl in HD ESA users; adjusted transfusion rates increased from 2.4 to 3.0 per 100 patient-months in PD and from 2.6 to 3.3 in HD patients.
  
  
  CONCLUSIONS
  In patients receiving persistent dialysis, dose and frequency of ESA administrations decreased during the period 2007-2011. Mean hemoglobin levels decreased by more than 1 g/dl, while transfusion rates increased by approximately 25%.
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minn., USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
authors.forename: Yi
authors.initials: Y
authors.lastname: Peng
authors.forename: Keri L
authors.initials: KL
authors.lastname: Monda
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Kats
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Kim
authors.forename: Brian D
authors.initials: BD
authors.lastname: Bradbury
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D000068817:Epoetin Alfa / Q000627:therapeutic use*; D017707:Erythrocyte Transfusion / Q000639:trends*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D000068817:Epoetin Alfa; D007501:Iron