Reddan Donal N, Frankenfield Diane L, Klassen Preston S, Coladonato Joseph A, Szczech Lynda, Johnson Curtis A, Besarab Anatole, Rocco Michael, McClellan William, Wish Jay, Owen William F
Duke Institute of Renal Outcomes Research and Health Policy, Duke University Medical Center, Durham, NC 27710, USA.
Nephrol Dial Transplant. 2003 Jan;18(1):147-52. doi: 10.1093/ndt/18.1.147.
Regional differences in haemoglobin values and process care measures were examined using data from the Centers for Medicare & Medicaid Services' End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. It was posited that regional differences in haemoglobin values are consequent upon differences in components of clinical practice.
A national random sample of 8336 adult, in-centre haemodialysis patients, stratified by the 18 regional ESRD Networks, was drawn. Information was collected for October-December 1998. Multivariable stepwise linear and logistic regression analyses were performed to identify variables associated with haemoglobin. Linear regression analysis was used to identify variables associated with Epo/Hb index (mean weight-adjusted treatment level erythropoietin (Epo) dose divided by mean haemoglobin).
The percentage of patients with haemoglobin concentration < 11 g/dl ranged from 34 to 52% across ESRD Networks. In addition to haemoglobin there was significant, non-random variation among ESRD Networks with regard to prescribed Epo dose and administration route, intravenous (IV) iron prescription and dialyser flux (high flux = KUf > or = 20 ml/mmHg/h) (all P-values < 0.001). Higher haemoglobin was associated with older age, male gender, higher serum albumin, higher transferrin saturation, higher Kt/V, lower serum ferritin and lower prescribed Epo dose (all P-values < 0.01). Diabetes mellitus as cause of ESRD, high-flux dialyser use, IV iron prescription or subcutaneous Epo prescription were not associated with haemoglobin. Male gender, diabetes as cause of ESRD, older age, higher transferrin saturation and higher albumin concentrations were associated with lower Epo/Hb index. Prescription of IV iron and IV Epo were associated with higher Epo/Hb index.
Regional mean haemoglobin levels vary considerably across the US and the variation in haemoglobin is explained by both non-modifiable factors and modifiable clinical practice-derived variables.
利用医疗保险与医疗补助服务中心的终末期肾病（ESRD）临床绩效衡量项目的数据，对血红蛋白值和治疗过程护理措施的地区差异进行了研究。研究假定，血红蛋白值的地区差异是临床实践各组成部分差异的结果。
抽取了一个全国性的随机样本，包括8336名接受中心血液透析的成年患者，按18个地区性ESRD网络进行分层。收集了1998年10月至12月的信息。进行了多变量逐步线性和逻辑回归分析，以确定与血红蛋白相关的变量。使用线性回归分析来确定与促红细胞生成素/血红蛋白指数（平均体重调整后的促红细胞生成素（Epo）治疗水平剂量除以平均血红蛋白）相关的变量。
ESRD网络中血红蛋白浓度<11 g/dl的患者百分比在34%至52%之间。除了血红蛋白外，ESRD网络在规定的Epo剂量和给药途径、静脉注射（IV）铁剂处方以及透析器通量（高通量=KUf>或=20 ml/mmHg/h）方面存在显著的非随机差异（所有P值<0.001）。较高的血红蛋白与年龄较大、男性、较高的血清白蛋白、较高的转铁蛋白饱和度、较高的Kt/V、较低的血清铁蛋白和较低的规定Epo剂量相关（所有P值<0.01）。作为ESRD病因的糖尿病、使用高通量透析器、IV铁剂处方或皮下Epo处方与血红蛋白无关。男性、作为ESRD病因的糖尿病、年龄较大、较高的转铁蛋白饱和度和较高的白蛋白浓度与较低的Epo/血红蛋白指数相关。IV铁剂和IV Epo的处方与较高的Epo/血红蛋白指数相关。
美国各地的地区平均血红蛋白水平差异很大，血红蛋白的差异可由不可改变的因素和可改变的临床实践衍生变量来解释。
