Division of Nephrology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Kidney Int. 2010 Jul;78(2):215-23. doi: 10.1038/ki.2010.108. Epub 2010 Apr 28.
Hemoglobin levels and the dose of erythropoiesis-stimulating agents (ESAs) have risen over time in hemodialysis patients within the United States. There are concerns that these trends may be driven by reimbursement policies that provide potential incentives to increase this use. To determine this we studied trends in the use of ESA and hemoglobin levels in hemodialysis patients and the relationship of these trends to the mode of reimbursement. Using the Dialysis Outcomes and Practice Patterns Study (DOPPS) database of hemodialysis we analyzed facility practices in over 300 randomly selected dialysis units in 12 countries. At each of three phases (years 1996-2001, 2002-2004, and 2005-present), we randomly selected over 7500 prevalent hemodialysis, hemofiltration, or hemodiafiltration patients. ESA usage rose significantly in every country studied except Belgium. All but Sweden demonstrated a substantial increase in hemoglobin levels. In 2005 more than 40% of patients had hemoglobin levels above the KDOQI upper target limit of 120 g/l in all but Japan. These trends appeared to be independent of the manner of reimbursement even though the United States is the only country with significant financial incentives promoting increased use of these agents. Thus, our study found that prescribing higher doses of ESAs and achieving higher hemoglobin levels by physicians reflects a broad trend across DOPPS countries regardless of the reimbursement policies.
在美国的血液透析患者中，血红蛋白水平和促红细胞生成素刺激剂（ESA）的剂量随着时间的推移而上升。有人担心这些趋势可能是由报销政策驱动的，这些政策可能会增加这种药物的使用。为了确定这一点，我们研究了血液透析患者中 ESA 的使用和血红蛋白水平的趋势，以及这些趋势与报销模式的关系。我们使用了 DOPPS（透析结果和实践模式研究）数据库，对来自 12 个国家的 300 多个随机选择的透析单位的机构实践进行了分析。在三个阶段（1996-2001 年、2002-2004 年和 2005 年至今）中，我们在每个阶段随机选择了超过 7500 名现有的血液透析、血液滤过或血液透析滤过患者。除了比利时，我们在每个研究的国家都观察到 ESA 的使用显著增加。除了瑞典，所有国家的血红蛋白水平都有实质性的提高。到 2005 年，除了日本，所有国家的患者中超过 40%的血红蛋白水平超过了 KDOQI 的上限目标值 120g/l。这些趋势似乎与报销方式无关，尽管美国是唯一一个有显著经济激励措施来促进这些药物使用的国家。因此，我们的研究发现，医生开更高剂量的 ESA 和实现更高的血红蛋白水平反映了 DOPPS 国家的广泛趋势，而与报销政策无关。
