Prospective evaluation of an anemia treatment algorithm in hemodialysis patients

Patterson, Patricia; Allon, Michael

doi:10.1016/s0272-6386(98)70028-9

Cited by 21 publications

(25 citation statements)

References 22 publications

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“…The final results achieved in the protocol group were comparable to those observed in a previous prospective cohort study that used an intravenous rHuEpo algorithm (20). The previous study showed that utilization of an anemia protocol led to an increase in patients with Hgb values in target range from 27% to 61% while reducing the proportion of patients below the target range from 46% to 18%.…”

Section: Discussionsupporting

confidence: 78%

“…Early termination of the study may have had an impact on the final results; it seems unlikely, however, that continuation of the study would have led to any measurable difference in the primary outcome. A previous study (20) demonstrated that implementation of an intravenous rHuEpo algorithm led to a measurable improvement in achieving target Hgb values after only 3 mo.…”

Section: Discussionmentioning

confidence: 99%

“…A study evaluating the effects of rHuEpo on left ventricular geometry used an algorithm in an attempt to standardize rHuEpo dosing across centers; however, the details of the algorithm were not described, and its effectiveness was not evaluated (19). A recent study demonstrated that utilization of an intravenous rHuEpo dosing algorithm in a small cohort of hemodialysis patients led to a greater number of patients achieving target Hgb levels (20). To our knowledge, no randomized, controlled trial has evaluated the efficacy of an anemia management team protocol.…”

mentioning

confidence: 99%

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Protocolized Anemia Management with Erythropoietin in Hemodialysis Patients

Brimble¹,

Rabbat²,

McKenna

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Treatment of the anemia of chronic renal failure with exogenous recombinant human erythropoietin (rHuEpo) is well established. The objective of this randomized clinical trial was to evaluate an anemia management team protocol in hemodialysis patients, using subcutaneous rHuEpo and intravenous iron. A total of 215 patients were randomized to either usual care or the protocol. The primary outcome was the proportion of patient hemoglobin (Hgb) values between 11.0 and 12.5 g/dl over the final 8 wk. The study was halted after 240 d because of an institutional change to intravenous rHuEpo. The proportion of Hgb values in the target range increased from 47.4% to 62.8% overall (P ϭ 0.001); there was no difference between treatment groups. The proportion of baseline Hgb values between 11.0 and 12.5 g/dl increased from 44.6% in patients who had enrolled within the first 3 mo of study inception to 75.0% in those who started later (P ϭ 0.017), suggesting a Hawthorne effect. A nonsignificant decrease in rHuEpo dose was observed in the protocol group; subgroup analysis in patients who were enrolled for at least 5 mo demonstrated a reduction in the rHuEpo dose of 2788 units/wk in the protocol group (P Ͻ 0.05), independent of intravenous iron dose. Multivariate analysis demonstrated that a higher transferrin saturation and albumin and protocol group assignment were associated with a lower final rHuEpo dose. This study demonstrated that a protocolized approach to anemia management in hemodialysis patients results in comparable Hgb levels and may reduce rHuEpo requirements, independent of iron use.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Protocolized Anemia Management with Erythropoietin in Hemodialysis Patients

Brimble¹,

Rabbat²,

McKenna

et al. 2003

Journal of the American Society of Nephrology

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“…Two early efforts were not developed, apparently. 12,14 Our group has provided a logical justification for clinical intervention by feedback, based on unit-wide defined thresholds of Hb, and used such systems in routine multicenter clinical practice for Ͼ8 yr. 18 We have also used the system in experimental studies, latterly to compare epoetins. 16 The data of this work were taken from this comparative study, extended by 3 mo of subsequent continuous algorithmic control.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment algorithms based on a feedback response to those trends will inevitably induce some periodic behavior. [12][13][14] It is likely that the amplitudes will depend both on the Hb threshold points of intervention and on some component of individual patient "sensitivity" (i.e., Hb response to a given change in epoetin dosage). Sensitivity measures have been attempted by a number of methods previously, although none is in routine application.…”

mentioning

confidence: 99%

Functional Data Analysis Applied to a Randomized Controlled Clinical Trial in Hemodialysis Patients Describes the Variability of Patient Responses in the Control of Renal Anemia

West

Harris

Gilthorpe

et al. 2007

Journal of the American Society of Nephrology

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The achievement of desirable hemoglobin levels in renal anemia that is treated with epoetins is often incomplete and subject to much variation of outcome values and applied dosage. The further development of clinical decision support for renal anemia requires the characterization of patient responses and an analysis of the dynamics of the dosage and response variables. In this methodologic article, the extended data of a randomized, controlled clinical trial comparing two epoetins were examined by the techniques of functional data analysis to establish how precisely the patterns of treatment response might be described and analyzed. The description of the trajectory of hemoglobin values in each patient as a mathematical function allowed the characterization of individual responses, with a wide variety of patterns being revealed. An analysis of the degree of system control in the management of the anemia was then possible through phase plotting. The analysis also allowed an expression of the dynamic characteristics of the entire experimental system, analyzed in summary group waveforms with standard statistical properties. In addition, a quantification of the notional instability of patient responses enabled the determination of a subset of patients for whom control might be improved in a modified management system. It is concluded that functional data analysis does provide the basis for further characterization and experimental study of the control of renal anemia.

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Intravenous iron dextran and erythropoietin use in pediatric hemodialysis patients

Greenbaum

Pan

Caley

et al. 2000

Pediatric Nephrology

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Recombinant human erythropoietin (rHuEPO) is an effective treatment for the anemia of chronic renal failure. However, adequate availability of iron is necessary for an optimal response. We prospectively evaluated the effect of an intravenous iron protocol in a pediatric hemodialysis unit. Patients with either a serum ferritin less than 150 ng/ml or transferrin saturation (TSAT) less than 20% received intravenous iron dextran during ten consecutive dialysis sessions. The administration of rHuEPO was adjusted using a protocol designed to maintain patient hematocrit between 33% and 36%. Thirteen courses of intravenous iron were evaluated. Patients received 4 mg/kg of iron dextran (maximum of 100 mg) during each of ten consecutive dialysis sessions. In 12 cases there was a decrease in rHuEPO use 2 months after completing the course of intravenous iron. The mean rHuEPO dose decreased from 3,784 units to 2,115 units (P<0.005). Based on the criteria of response to intravenous iron, a percentage iron saturation of less than 20% had a high specificity for detecting iron deficiency. All patients who received a course of intravenous iron had a TSAT less than 20%. The measurement of serum ferritin was less useful in our patients.

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Prospective evaluation of an anemia treatment algorithm in hemodialysis patients

Cited by 21 publications

References 22 publications

Protocolized Anemia Management with Erythropoietin in Hemodialysis Patients

Protocolized Anemia Management with Erythropoietin in Hemodialysis Patients

Functional Data Analysis Applied to a Randomized Controlled Clinical Trial in Hemodialysis Patients Describes the Variability of Patient Responses in the Control of Renal Anemia

Intravenous iron dextran and erythropoietin use in pediatric hemodialysis patients

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