The medical care of renal anaemia has received much attention over the past decade, as nephrologists have recognized the increased therapeutic value of erythropoiesis-stimulating agents. The European Best Practice Guidelines and the US National Kidney Foundation's Kidney Disease Outcome Quality Initiative Guidelines have provided evidence-based advice on the optimal treatment of renal anaemia, and have recommended a target haemoglobin (Hb) level of 11 g/dl or 11-12 g/dl. Achieving this target Hb level has been shown to improve quality of life and reduce the rate of hospitalization; there is also good evidence to suggest that achieving adequate Hb levels reduces morbidity and mortality in patients with end-stage renal disease. In recent years, a number of factors have been identified that may counteract the positive action of epoetin therapy. These treatment-influencing factors include inadequate haemodialysis, absolute and functional iron deficiency, anticoagulant use, inflammation and infection. Each factor on its own may result in a substantial decrease in Hb levels, or an increase in epoetin requirements of up to 100%. Therefore, optimal and cost-effective treatment can only be achieved by adequately managing all of the factors that potentially can influence anaemia in patients with chronic kidney disease. Large-scale, cross-sectional surveys, such as the European Survey on Anaemia Management and the Dialysis Outcomes and Practice Patterns Study, have shown that there is still room for improving the efficacy and efficiency of anaemia therapy. The Optimal Treatment of Renal Anaemia (OPTA) initiative aims to help both physicians and nurses improve renal anaemia management by "translating" the standards set in published guidelines into practical clinical advice.

Results. The percentages on PD of total incident (Inc PD %) and prevalent dialysis patients (Prev PD %) were 15.9% and 10.3%, respectively with considerable variations from region to region and from centre to centre. The Inc PD % was higher in regions with fewer patients on dialysis in private centres. In the private centres, the Inc PD % was 0.4%. Of the 325 nonpaediatric public centres, 116 (35.7%) do not use PD: compared with the 209 centres which do, these centres have a lower mean Inc HD þ PD and Prev HD þ PD per centre (13.0 AE 12.3 vs 28.6 AE 18.0 À 51.8 AE 35.7 vs 117.3 AE 66.4 patients, P < 0.0001), and more haemodialysis (HD) stations available (3.0 vs 3.5 patients per HD station, P < 0.0001). However, the significant influence of cultural and motivational factors on the use of this method is demonstrated by the fact that it is used by 34% of the smaller non-paediatric public centres, and is not used by 19% of the larger nonpediatric public centres.

BackgroundTo understand how peritoneal dialysis (PD) was being used in Italy in 2005 and 2008, a census of all centers was carried out.MethodsIn 2005 and 2008, data were collected from, respectively, 222 and 223 centers, with respect to 4432 and 4094 prevalent patients.ResultsIn the two periods, the PD incidence remained stable (24.3% vs 22.9%), varying from center to center. Continuous ambulatory PD (CAPD) was the main initial method (55%), but APD was more widespread among prevalent patients (53%). Among patients returning to dialysis from transplantation (Tx), PD was used in 10%. The use of incremental CAPD increased significantly from 2005 to 2008, in terms both of the number of centers (27.0% vs 40.9%) and of patients (13.6% vs 25.7%). Late referrals remained stable at 28%, with less use of PD. The overall drop-out rate (episodes/100 patient–years) remained unchanged (31.0 vs 32.8), with 13.1 and 12.9 being the result of death, and 11.8 and 12.4 being the result of a switch to hemodialysis, mainly after peritonitis. A dialysis partner was required by 21.8% of the PD patients. The incidence of peritonitis was 1 episode in 36.5 and 41.1 patient–months, with negative cultures occurring in 17.1% of cases in both periods. The incidence of encapsulating peritoneal sclerosis (episodes/100 patient–years) was 0.70, representing 1.26% of patients treated. The catheter types used and the sites and methods of insertion varied widely from center to center.ConclusionsThese censuses confirm the good results of PD in Italy, and provide insight into little-known aspects such as the use of incremental PD, the presence of a dialysis partner, and the incidence of encapsulating peritoneal sclerosis.

Background/Aims: Hemodialysis (HD) patients often show impaired response to erythropoiesis-stimulating agents (ESAs). Extended HD membrane permeability may potentially improve ESA response. Methods: Twenty-four prevalent HD patients were randomly assigned to 12 weeks use of high cut-off (HCO) membrane (in every second dialysis treatment) or continued treatment with high-flux membrane. We monitored changes in hemoglobin (Hb), ESA dose, and key biochemical markers. Results: The Hb level increased in the study group (from 11.6 ± 1.0 to 12.5 ± 1.5 g/dl; p = 0.038) but was stable in the control group. Variation over time in ESA dose and ESA resistance index did not differ between groups. HCO membrane usage for 12 weeks led to decreased hepcidin level, from 303 ± 189 to 157 ± 83 ng/ml (p = 0.024); serum albumin level decreased and stabilized 15 ± 6% below baseline. Conclusions: These results indicate that use of a more permeable dialysis membrane may improve ESA responsiveness in iron-replete HD patients. Extensive albumin removal may preclude long-term use of the HCO membrane.

No abstract