title: Total Red Blood Cell Transfusions for Chronic Hemodialysis Patients in a Single Center, 2009-2013.
abstract: BACKGROUND
  Anemia management in chronic hemodialysis (HD) has been affected by the implementation of the prospective payment system (PPS) and changes in clinical guidelines. These factors could impact red blood cell (RBC) transfusion in HD patients. Our distinctive care system contains complete records for all RBC transfusions among our HD patients.
  
  
  OBJECTIVE
  To determine RBC transfusions in patients with prevalent chronic HD, site of administration (inpatient or outpatient), and ordering physician specialty for inpatients; compare pre- and post-PPS RBC transfusions; and compare RBC transfusions during changes in desired outpatient hemoglobin (Hb) range for patients with chronic HD.
  
  
  METHODS
  Retrospective analysis of medical and blood bank records for patients with prevalent chronic HD July 2009 through June 2013.
  
  
  RESULTS
  In total, 310-356 patients were studied. Mean (SD) units of RBCs per 100 patients per month for the study's 48 months were outpatient, 2.6 (1.5), and inpatient, 9.4 (4.6). Outpatient pre-PPS RBC units transfused were 2.1 (0.6) vs. post-PPS of 2.6 (1.5; p = 0.22, t test); for inpatients pre-PPS, 7.9 (4.5) RBC units per month vs. post-PPS, 11.5 (5.1; p = 0.11, t test). Inpatient RBC transfusions accounted for 75.2% (14.2%) of all RBC transfusions; 67.3% (16.3%) of inpatient transfusions were ordered by nonnephrologists. Changes in desired Hb range for outpatient HD patients did not lead to changes in RBC transfusions.
  
  
  CONCLUSIONS
  No changes in RBC transfusions occurred among our patients with chronic HD with PPS implementation and in desired Hb range during the study period. Most transfusions were given in inpatient settings by nonnephrologists.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Albright
authors.forename: John J
authors.initials: JJ
authors.lastname: Dillon
authors.forename: Craig L
authors.initials: CL
authors.lastname: Hocum
authors.forename: James R
authors.initials: JR
authors.lastname: Stubbs
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Johnson
authors.forename: LaTonya J
authors.initials: LJ
authors.lastname: Hickson
authors.forename: Amy W
authors.initials: AW
authors.lastname: Williams
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.forename: James T
authors.initials: JT
authors.lastname: McCarthy
mesh_terms: D000740:Anemia / Q000628:therapy*; D017707:Erythrocyte Transfusion; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006435:Renal Dialysis
chemical_list: D006454:Hemoglobins