Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN; Department of Medicine, University of Minnesota, Minneapolis, MN.
Center for Observational Research, Amgen, Inc, Thousand Oaks, CA.
Am J Kidney Dis. 2014 Jun;63(6):997-1006. doi: 10.1053/j.ajkd.2013.10.052. Epub 2013 Dec 4.
Changes in anemia management practices due to concerns about erythropoiesis-stimulating agent safety and Medicare payment changes may increase patient risk of transfusion. We examined anemia management trends in hemodialysis patients and risk of red blood cell (RBC) transfusion according to dialysis facility-level hemoglobin concentration.
Retrospective follow-up study; 6-month study period (January to June), 3-month exposure/follow-up.
SETTING & PARTICIPANTS: For each year in 2007-2011, annual cohorts of point-prevalent Medicare primary payer patients receiving hemodialysis on January 1 with one or more hemoglobin measurements during the study period. Annual cohorts averaged 170,000 patients, with 130,000 patients and 3,100 facilities for the risk analysis.
Percentage of facility patient-months with hemoglobin level<10 g/dL.
Patient-level RBC transfusion rates.
Monthly epoetin alfa and intravenous iron doses, mean hemoglobin levels, and RBC transfusion rates; percentage of facility patient-months with hemoglobin levels<10 g/dL (exposure) and patient-level RBC transfusion rates (follow-up).
Percentages of patients with hemoglobin levels<10 g/dL increased every year from 2007 (6%) to 2011 (~11%). Epoetin alfa doses, iron doses, and transfusion rates remained relatively stable through 2010 and changed in 2011. Median monthly epoetin alfa and iron doses decreased 25% and 43.8%, respectively, and monthly transfusion rates increased from 2.8% to 3.2% in 2011, a 14.3% increase. Patients in facilities with the highest prevalence of hemoglobin levels<10 g/dL over 3 months were at ~30% elevated risk of receiving RBC transfusions within the next 3 months (relative risk, 1.28; 95% CI, 1.22-1.34).
Possibly incomplete claims data; smaller units excluded; hemoglobin levels reported monthly for patients receiving epoetin alfa; transfusions usually not administered in dialysis units.
Dialysis facility treatment practices, as assessed by percentage of patient-months with hemoglobin levels<10 g/dL over 3 months, were associated significantly with risk of transfusions in the next 3 months for all patients in the facility, regardless of patient case-mix.
由于担心促红细胞生成素刺激剂的安全性和医疗保险支付变化，贫血管理实践发生了变化，这可能会增加患者输血的风险。我们研究了血液透析患者的贫血管理趋势，并根据透析中心的血红蛋白浓度观察红细胞（RBC）输血的风险。
回顾性随访研究；6 个月的研究期（1 月至 6 月），3 个月的暴露/随访。
每年从 2007 年至 2011 年，在研究期间有一个或多个血红蛋白测量值的每月初诊 Medicare 主要支付者接受血液透析的患者年度队列。每年的队列平均有 17 万名患者，其中有 13 万名患者和 3100 个设施进行风险分析。
血红蛋白水平<10 g/dL 的设施患者月百分比。
患者 RBC 输血率。
每月促红细胞生成素 alfa 和静脉内铁剂量、平均血红蛋白水平和 RBC 输血率；血红蛋白水平<10 g/dL 的设施患者月百分比（暴露）和患者 RBC 输血率（随访）。
血红蛋白水平<10 g/dL 的患者百分比从 2007 年（6%）逐年增加到 2011 年（~11%）。促红细胞生成素 alfa 剂量、铁剂量和输血率在 2010 年之前保持相对稳定，然后在 2011 年发生变化。每月促红细胞生成素 alfa 和铁剂量分别下降 25%和 43.8%，每月输血率从 2011 年的 2.8%增加到 3.2%，增加了 14.3%。在 3 个月内血红蛋白水平<10 g/dL 发生率最高的设施中，患者在下一个 3 个月内接受 RBC 输血的风险约增加 30%（相对风险，1.28；95%CI，1.22-1.34）。
可能不完全的索赔数据；排除较小的单位；接受促红细胞生成素 alfa 治疗的患者每月报告血红蛋白水平；通常不在透析单位进行输血。
以 3 个月内血红蛋白水平<10 g/dL 的患者月百分比评估的透析设施治疗方法与设施内所有患者下一个 3 个月内输血的风险显著相关，而与患者病例组合无关。
