4 We performed preliminary data analysis on anemia management and outcomes in 1,276 patients undergoing hemodialysis (HD) and enrolled in the CRC for ESRD. The patients were enrolled between July 2009 and June 2011 and were followed until December
2011. The mean age of patients undergoing HD was 59.6 years. Of the entire cohort of patients, 58.4% were male, 52.4% had a history of diabetes, and 43.3% (n = 552) were incident patients. At enrollment, the mean hemoglobin (Hb) level of the entire cohort, the incident patients, and the prevalent patients were 9.9 ± 1.7 g/dL, 8.8 ± 1.7 g/dL, and 10.7 ± 1.2 g/dL, respectively. ESAs were prescribed in 76.4% of the entire cohort, with a median dose of 8,000 units/week of epoetin in 70.9% of incident patients and 80.9% of prevalent patients. Intravenous iron was prescribed selleck chemical in 8.1% of the entire cohort, 9.2% of the incident patients, and 7.3% of the prevalent patients. The mean levels of TSAT and serum ferritin were 30.6% ± 15.9% and 292.9 ± 307.6 ng/mL, respectively. Hb levels correlated positively with serum albumin levels and dialysis adequacy
(Kt/V), whereas it correlated negatively with serum ferritin and high-sensitivity C-reactive protein (hs-CRP) levels. Multivariate linear regression analysis identified serum albumin (β = 0.408; P < 0.001) and Kt/V (β = 0.129; P < 0.001) and serum hs-CRP (β = -0.070; P = 0.006) as independent predictors Selleckchem EMD 1214063 for anemia. Sixty incident patients (10.8%) and 77 prevalent patients (10.6%) died
during the mean follow-up of 19.4 ± 8.5 months. The most common cause of death was infectious disease. After adjusting for age, dialysis vintage, comorbidities, iron status, and ESA dose, a lower Hb level was associated with mortality in the entire cohort. With an Hb level of 10–11 g/dL as a reference, hazard ratios associated with time-dependent Hb levels were 5.12 (2.62–10.02) for Hb levels <9.0 g/dL and 2.03 (1.16–3.69) for Hb levels 9–10 g/dL. In summary, compared with the international practice pattern for anemia management, intravenous iron administration was much lower in patients enrolled in CRC 5-FU clinical trial for ESRD. In addition, the survival benefit of higher Hb (>11.0 g/dL) levels was not seen in this Korean observational cohort. 1. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int. 2012; 2(4): 1–64. 2. Pisoni RL, Bragg-Gresham JL, Young EW, Akizawa T, Asano Y, Locatelli F, Bommer J, Cruz JM, Kerr PG, Mendelssohn DC, Held PJ, Port FK. Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004; 44(1):94–111. 3. Fuller DS, Pisoni RL, Bieber BA, Port FK, Robinson BM. The DOPPS practice monitor for U.S. dialysis care: update on trends in anemia management 2 years into the bundle. Am J Kidney Dis.