Frankenfield D, Johnson C A, Wish J B, Rocco M V, Madore F, Owen W F
Health Care Financing Administration, Baltimore, MD 21244, USA.
Kidney Int. 2000 Feb;57(2):578-89. doi: 10.1046/j.1523-1755.2000.00878.x.
The Health Care Financing Administration's End-Stage Renal Disease (ESRD) Core Indicators Project collects clinical information on prevalent adult patients receiving in-center hemodialysis (HD) care in the United States to assess the quality of care delivered. Although hematocrit values, transferrin saturations, and iron prescription practices have improved over the last five years, we sought to determine whether continued opportunities for improvement of this domain of care exist.
A random sample of 7292 adult in-center HD patients was selected. Dialysis facility staff provided clinical information for the period of October through December 1996 for 6858 (94%) patients; complete laboratory information was available from 4991 (73%) returned forms. Hematocrit values, transferrin saturations, serum ferritin concentrations, epoetin alfa dosing, and iron prescriptions were abstracted from patient medical records to assess anemia management practices.
The mean hematocrit for this cohort was 32.6 +/- 3.5%. Seventy-two percent of patients had hematocrit values> 30%. Forty-two percent had hematocrit values of 33 to 36%, and 10% were severely anemic (hematocrit <28%). Ninety-four percent of the patients received epoetin alfa intravenously (i.v.) and 6% subcutaneously. The mean weekly dose was 202.4 +/- 137.2 units/kg. The mean transferrin saturation was 27.4 +/- 12.6%; 73% of patients had a mean transferrin saturation > or = 20%. The mean serum ferritin concentration was 386 +/- 422 ng/mL; 79 and 12% of patients had a serum ferritin concentration of> 100 and> 800 ng/mL, respectively. Nine percent of the sample (N = 434) had a transferrin saturation <20% and serum ferritin concentration <100 ng/mL. Regardless of the patient's transferrin saturation, approximately three fourths of the patients received either oral or i.v. iron, and only approximately one half of the patients received i.v. iron. Of the subset of patients with transferrin saturation <20% and serum ferritin concentration <800 ng/mL, only 53% were prescribed intravenous iron. Multivariate linear regression analysis revealed that serum albumin, urea reduction ratio, age, and transferrin saturation were significantly positively associated with hematocrit. Epoetin alfa dose and serum ferritin concentration were significantly and negatively associated with the hematocrit (P < 0.001).
Although substantial improvements have been made in anemia management for adult in-center HD patients over the past five years, significant opportunities persist to improve iron prescription practices.
医疗保健财务管理局的终末期肾病（ESRD）核心指标项目收集了美国接受中心血液透析（HD）治疗的成年患者的临床信息，以评估所提供的护理质量。尽管在过去五年中血细胞比容值、转铁蛋白饱和度和铁剂处方做法有所改善，但我们试图确定在这一护理领域是否仍存在持续改进的机会。
选取了7292名接受中心血液透析的成年患者作为随机样本。透析机构工作人员提供了1996年10月至12月期间6858名（94%）患者的临床信息；4991份（73%）返回表格提供了完整的实验室信息。从患者病历中提取血细胞比容值、转铁蛋白饱和度、血清铁蛋白浓度、促红细胞生成素α剂量和铁剂处方，以评估贫血管理做法。
该队列的平均血细胞比容为32.6±3.5%。72%的患者血细胞比容值>30%。42%的患者血细胞比容值为33至36%，10%为重度贫血（血细胞比容<28%）。94%的患者接受静脉注射促红细胞生成素α，6%接受皮下注射。平均每周剂量为202.4±137.2单位/千克。平均转铁蛋白饱和度为27.4±12.6%；73%患者的平均转铁蛋白饱和度≥20%。平均血清铁蛋白浓度为386±422纳克/毫升；分别有79%和12%的患者血清铁蛋白浓度>100纳克/毫升和>800纳克/毫升。9%的样本（N = 434）转铁蛋白饱和度<20%且血清铁蛋白浓度<100纳克/毫升。无论患者的转铁蛋白饱和度如何，约四分之三的患者接受口服或静脉铁剂治疗，只有约一半的患者接受静脉铁剂治疗。在转铁蛋白饱和度<20%且血清铁蛋白浓度<800纳克/毫升的患者亚组中，只有53%的患者被处方静脉铁剂。多变量线性回归分析显示，血清白蛋白、尿素清除率、年龄和转铁蛋白饱和度与血细胞比容显著正相关。促红细胞生成素α剂量和血清铁蛋白浓度与血细胞比容显著负相关（P<0.001）。
尽管在过去五年中成年中心血液透析患者的贫血管理有了显著改善，但在改善铁剂处方做法方面仍存在重大机会。
