2004 Japanese Society for Dialysis Therapy Guidelines for Renal Anemia in Chronic Hemodialysis Patients*

Gejyo, Fumitake; Saitō, Akira; Akizawa, Tadao; Akiba, Takashi; Sakai, Tatsuya; Suzuki, Masashi; Nishi, Shinichi; Tsubakihara, Yoshiharu; Hirakata, Hideki; Bessho, Masami

doi:10.1111/j.1774-9987.2004.00199.x

Cited by 67 publications

(63 citation statements)

References 72 publications

(50 reference statements)

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“…8 As compared with Hct, Hgb is seen to be a better measure to use to monitor and manage anemia in patients with chronic kidney disease. 9,10 The JSDT 2004 Guideline briefl y reported that Hct levels on Mondays (the beginning day of the dialysis week) were considered to be corresponded to 99.1% of those on Wednesdays (the middle day of the dialysis week). 7 Results from the present study also demonstrated that Hct levels at the beginning day of the dialysis week were corresponded to 96.9% of those at mid-dialysis week.…”

Section: Discussionmentioning

confidence: 99%

Difference in Hemoglobin Concentration by Timing of Blood Sampling in Hemodialysis Patients

Shimazaki¹

2009

Dialysis & Transplantation

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OBJECTIVEThe degree of interdialytic weight gain (IDWG) may have an influence on anemia results. This article reports the variation of hemoglobin (Hgb) or hematocrit (Hct) levels associated with the timing of blood collection in outpatients on hemodialysis.METHODSPre‐dialysis blood samples for measurement were drawn on both the mid‐week treatment (Wednesday or Thursday) and the beginning of the next dialysis week treatment (Monday or Tuesday) in 69 patients who were hemodialyzed 3 times a week.RESULTSHgb or Hct results from mid‐week were significantly higher than those from the beginning of the next week. Change in Hgb or Hct was correlated negatively with change in IDWG.DISCUSSIONIt seems that there was a difference in Hgb or Hct levels associated with IDWG on the day of the week on which blood was collected.

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Section: Discussionmentioning

confidence: 99%

Difference in Hemoglobin Concentration by Timing of Blood Sampling in Hemodialysis Patients

Shimazaki¹

2009

Dialysis & Transplantation

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“…The presence of anaemia, defined as a haemoglobin concentration <120 g/l in women and <130 g/l in men (a sex-specific definition established by the WHO [22]), was observed in 19 (12.8%) women and 32 (10.2%) men. Using the sexand age-specific anaemia criteria in Japanese adults proposed by the Japanese Society for Dialysis Therapy Guidelines [23], only 6 (4.0%) women and 12 (3.8%) men were diagnosed as having anaemia. Based on ADAguideline criteria [18], 126 (84.6%) women and 252 (80.0%) men were classified as having normoalbuminuria, and 23 (15.4%) women and 63 (20.0%) men were classified as having microalbuminuria; 26 (17.4%) [24].…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

et al. 2006

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Aims/hypothesis: Anaemia has been suggested to be an independent risk factor for subsequent progression of advanced diabetic nephropathy; however, the relationship between haemoglobin levels and progression of nephropathy in patients without clinical albuminuria is unknown. Methods: We conducted this prospective hospital-based cohort study of 464 type 2 diabetic patients (149 women and 315 men, 55±13 [mean±SD] years of age) with serum creatinine <177 μmol/l (2.00 mg/dl) and urinary albumin : creatinine ratio <300 mg/g creatinine. GFR was estimated using the equation formulated by the Modification of Diet in Renal Disease Study group, refitted for Japanese individuals. Most patients had haemoglobin concentrations in the normal range (144±15 g/l), only modest renal impairment (GFR: 74.8±14.5 ml min −1 1.73 m −2 ), and normal urinary albumin levels (81.5/18.5% with normo-/microalbuminuria). The primary outcome measurement was the rate of change in GFR determined by regression analysis with GFR as a function of time. Patients were followed up for a mean observation period of 5.0±0.9 (range: 2.5 to 6.2) years. Results: Univariate and multiple regression analyses yielded a significant association between the rate of change in GFR and baseline haemoglobin concentration. After adjusting for covariates, the rate of decline in GFR was significantly greater in patients in the lowest haemoglobin quartile (−3.27 ml min −1 1.73 m −2 year −1 ) than in the third (−2.71 ml min −1 1.73 m −2 year −1 , p=0.024) and highest quartiles (−2.78 ml min −1 1.73 m −2 year −1 , p=0.046). Conclusions/interpretation: Lower haemoglobin concentrations in type 2 diabetic patients without clinical albuminuria may be a significant predictor of subsequent decline in GFR.

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“…However, the Japanese Society for Dialysis Therapy (JSDT) published anemia management guidelines in 2004 that recommended an Hb target level of 10-11 g/dl for most patients and 11-12 g/dl for younger, more active patients. 27 A 2008 update to the JSDT guidelines added 12 g/dl as a criterion for reducing or interrupting ESA treatment. 28 Although the distribution of lower Hb targets reported by Japanese DOPPS facilities has not changed much since 2010 ( Figure 3B), in recent years, we have observed a higher proportion of Japanese DOPPS facilities reporting upper Hb targets of 12 g/dl ( Figure 3A).…”

Section: Anemia Treatment Targets: 2010-2013mentioning

confidence: 99%

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

Fuller

Bieber

Pisoni

et al. 2015

JASN

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For years, erythropoiesis-stimulating agent (ESA) use among patients on dialysis was much higher in the United States than in Europe or Japan. Sweeping changes to dialysis reimbursement and regulatory policies for ESA in the United States in 2011 were expected to reduce ESA use and hemoglobin levels. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS) data from 7129 patients in 223 in-center hemodialysis facilities (average per month) to estimate and compare time trends in ESA dose and hemoglobin levels among patients on hemodialysis in the United States, Germany, Italy, Spain, the United Kingdom, and Japan. From 2010 to 2013, substantial declines in ESA use and hemoglobin levels occurred in the United States but not in other DOPPS countries. Between August of 2010 and April of 2013, mean weekly ESA dose in the United States decreased 40.4% for black patients and 38.0% for nonblack patients; mean hemoglobin decreased from 11.5 g/dl in black patients and 11.4 g/dl in nonblack patients to 10.6 g/dl in both groups. In 2010 and 2013, adjusted weekly ESA doses per kilogram were 41% and 11% lower, respectively, in patients in Europe and 60% and 18% lower, respectively, in patients in Japan than in nonblack patients in the United States. Adjusted hemoglobin levels in 2010 and 2013 were 0.07 g/dl lower and 0.56 g/dl higher, respectively, in patients in Europe and 0.93 and 0.01 g/dl lower, respectively, in patients in Japan than in nonblack patients in the United States. In conclusion, ESA dosing reductions in the United States likely reflect efforts in response to changes in reimbursement policy and regulatory guidance. 27: 220527: -221527: , 201627: . doi: 10.1681 Deficient renal erythropoietin production is a major factor contributing to the anemic status that affects the vast majority of patients on dialysis. 1 Treatment with erythropoiesis-stimulating agents (ESAs) and intravenous (iv) iron has been the cornerstone of anemia management for over two decades. 9 on the matter, data from the US Renal Data System were shared that indicated that more than one half of United States patients on dialysis had Hb levels above the US Food and Drug Administration 10 (FDA) target range of 10-12 g/dl, and the US Government Accounting Office 11 (GAO) presented a 2006 report recommending implementation of an expanded bundled payment for dialysis services including renal medications and laboratory services. Subsequent regulatory action culminated in three important changes that occurred in 2011. In January of 2011, the US Centers for Medicare and Medicaid Services (CMS) introduced a major modification to the ESRD Prospective Payment System (PPS) that was fully implemented nearly 90% of United States dialysis units, with the remainder opting to phase in over 4 years. The revised PPS added approximately $3 billion worth of separately billable services to the bundled payment, of which dose-based reimbursement for ESAs and iv iron accounted for approximately 67% and 8%, respectively. 12 In June of 2011, the FD...

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2004 Japanese Society for Dialysis Therapy Guidelines for Renal Anemia in Chronic Hemodialysis Patients*

Cited by 67 publications

References 72 publications

Difference in Hemoglobin Concentration by Timing of Blood Sampling in Hemodialysis Patients

Difference in Hemoglobin Concentration by Timing of Blood Sampling in Hemodialysis Patients

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

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