Poor Compliance with Guidelines on Anemia Treatment in a Cohort of Chronic Hemodialysis Patients

Abstract

Background/Aims: Guidelines for the management of anemia and iron deficiency in chronic hemodialysis (HD) patients have been developed to standardize therapy and improve clinical outcome. The present study evaluated compliance with anemia guidelines and investigated whether differences between centers were present. Methods: Data on anemia management from patients in the baseline cohort of the CONTRAST study (NCT00205556) were analyzed. 598 chronic HD patients (62% male, age 63.6 ± 14.0 years) from 26 Dutch dialysis centers were included. Results: Mean hemoglobin (Hb) level was 11.9 ± 1.3 g/dl and Hb was ≥11.0 g/dl in 81% of the patients. Compliance with all anemia targets (Hb 11.0–12.0 g/dl, transferrin saturation ratio ≥20%, ferritin 100–500 ng/ml) was reached in 11.6% (95% CI 7.8–17.0) of the patients, with a wide range among centers (4–26%, adjusted for case mix, treatment-related factors and center-specific characteristics). Conclusion: Compliance with anemia targets in stable HD patients was poor and showed a wide variation between treatment facilities.

Cardiovascular Disease in Hemodialysis Patients

“…Guidelines for the management of anemia and iron deficiency in chronic hemodialysis (HD) patients have been developed to standardize therapy and improve clinical outcome. But a recent Dutch study found that compliance with anemia targets in stable HD patients was poor and showed a wide variation between treatment facilities [40].…”

What Have We Learned from CONTRAST?

“…This study demonstrated that the compliance with all anemia targets (Hb 11.0-12.0 g/dl, transferrin saturation ratio ≥20%, ferritin 100-500 ng/ml) was reached in only 12% of the patients. The adherence percentages varied greatly among centers (4-26%), even after adjustment for treatment-related factors and center-specific characteristics [22]. …”

The effect of thyme honey on anemia in hemodialysis patients

“…The World Health Organization (WHO) defines anemia as hemoglobin level less than 13 g/dl in men and less than 12 g/dl in women (6). In the hemodialysis patients, the hemoglobin levels over 13 g/dl are not associated with a decrease in cardiovascular disease and their mortality rates, and their recommended hemoglobin levels are over 11 g/dl (8).…”