title: The Impact of Lowering Haemoglobin Targets on Patterns of Erythropoiesis-Stimulating Agent Use in Patients on Haemodialysis.
abstract: OBJECTIVE
  Haemoglobin (Hb) targets have been reduced in patients receiving haemodialysis (HD). We have investigated the impact of new guidance on current practices and costs.
  
  
  METHODS
  Anaemia management in all patients undergoing thrice-weekly HD was retrospectively reviewed. Hb targets were compared against Kidney Disease: Improving Global Outcomes 2012 recommendations. The impact of new guidance was assessed by comparing anaemia parameters pre- and post-guideline publication.
  
  
  RESULTS
  Two hundred and ninety two patients, with a mean age of 64 years were included. The Hb target range was achieved in 44% patients and was above target in 51%. In a sub-group of 230 patients, the mean Hb did not differ during Q4-2011 and Q4-2012. A reduction in erythropoiesis-stimulating agent (ESA) use was observed. ESA efficiency (Hb/ESA) increased in the later period (6.08 vs. 6.41 g/l/μg) and was associated with a 3% cost reduction.
  
  
  CONCLUSIONS
  Introduction of guidelines lowering Hb targets in HD patients led to more efficient ESA usage and cost-savings. Anaemia treatment, however, remains unnecessarily aggressive in some patients. Further reductions in Hb and ESA dose are achievable.
authors.affiliation: Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust, Kingston upon Hull, UK.
authors.forename: Adil M
authors.initials: AM
authors.lastname: Hazara
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Owen
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhandari
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure / Q000187:drug effects; D004920:Erythropoiesis / Q000187:drug effects; D005260:Female; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000191:economics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D005293:Ferritins