Anemia Management in the China Dialysis Outcomes and Practice Patterns Study

Abstract

Background: As the utilization of hemodialysis increases in China, it is critical to examine anemia management. Methods: Using data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS), we describe hemoglobin (Hgb) distribution and anemia-related therapies. Results: Twenty one percent of China's DOPPS patients had Hgb <9 g/dl, compared with ≤10% in Japan and North America. A majority of medical directors targeted Hgb ≥11. Patients who were female, younger, or recently hospitalized had higher odds of Hgb <9; those with insurance coverage or on twice weekly dialysis had lower odds of Hgb <9. Iron use and erythropoietin-stimulating agents (ESAs) dose were modestly higher for patients with Hgb <9 compared with Hgb in the range 10-12. Conclusion: A large proportion of hemodialysis patients in China's DOPPS do not meet the expressed Hgb targets. Less frequent hemodialysis, patient financial contribution, and lack of a substantial increase in ESA dose at lower Hgb concentrations may partially explain this gap. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=442741.

Epoetin alfa resistance in hemodialysis patients with chronic kidney disease: a longitudinal study

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“…Several factors contribute to the development of anemia in patients with CKD, including nutritional deficiencies, an inflammatory state, and blood losses related to the dialysis procedure. However, the primary cause of anemia is erythropoietin (EPO) deficiency resulting from diminished production in the kidneys ( 3 , 4 ).…”

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“…The incidence and severity of anemia are gradually increasing as renal function declining [56]. In 2016, China Dialysis Outcomes and Practice Patterns Study (China's DOPPS) showed the prevalence of anemia in CKD being 21% [57]. Anemia can increase the proportion of left ventricular hypertrophy, cause heart failure and myocardial infarction, reduce quality of life and increase the risk of death.…”

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“…However, an inadequate dialysis dose may increase the accumulation of uremic toxin and lead to suppressed RBC production and low response to ESA in addition to the low frequency and low dose of ESA administration (). Patients in China on twice‐weekly HD had higher likelihood of Hgb <9 g/dl (). The reason was postulated as patients on twice‐weekly HD are more likely to have less insurance coverage and are less likely to meet dialysis adequacy targets compared with those on thrice‐weekly HD ().…”