The Dialysis Outcomes and Practice Patterns Study (DOPPS): Design, data elements, and methodology

Pisoni, Ronald L.; Gillespie, Brenda W.; Dickinson, David M.; Chen, Kenneth; Kutner, Michael; Wolfe, Robert A.

doi:10.1053/j.ajkd.2004.08.005

Cited by 206 publications

(162 citation statements)

References 4 publications

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“…In comparison, the data from this analysis suggest that the Hb levels at the time of transfusion were substantially lower, on average 8.9 g/dl in the inpatient setting and 8.5 g/dl in the outpatient setting. This, however, may be explained by the considerable differences in the prevalence of ESA (90%) and iron therapy (70 to 80%) in dialysis versus nondialysis patients, previously reported (27% for ESA and 45% for iron) (14).…”

Section: Discussionmentioning

confidence: 66%

Transfusion Burden among Patients with Chronic Kidney Disease and Anemia

Lawler

Bradbury

Fonda

et al. 2010

Clinical Journal of the American Society of Nephrology

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Results: Among 97,636 patients with CKD and anemia, we observed 68,556 transfusion events (61 events per 100 personyears), 86.6% of which occurred in inpatient settings. At all Hb levels, transfusion events were highest during periods of no treatment and increased with declining Hb levels. Between an Hb of 10.0 and 10.9 g/dl, the transfusion rate was 2.0% for those who received an ESA, iron, or both and 22% for those who received no treatment; at an Hb level of 7.0 to 7.9 g/dl, the transfusion rate was 10 to 12% for treated and 58% for untreated patients. Low absolute Hb levels but not Hb changes was most predictive of a transfusion even after adjustment for patient case mix.Conclusions: Transfusions are still used to treat anemia in patients who have CKD and do not require dialysis, although they occur considerably less frequently in patients who receive other available anemia therapies.

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Section: Discussionmentioning

confidence: 66%

Transfusion Burden among Patients with Chronic Kidney Disease and Anemia

Lawler

Bradbury

Fonda

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…The study design has been described elsewhere. 7 Briefly, a representative sample of hemodialysis facilities was selected in each country (Australia/New Zealand, Belgium, Canada, France, Germany, Italy, Spain, Sweden, and United Kingdom, twenty facilities each; Japan, sixty facilities; and United States, eighty facilities). A random sample of patients was selected within each facility, representing a prevalent cross-section of patients (N = 7,766).…”

Section: Study Data and Methodsmentioning

confidence: 99%

Out-Of-Pocket Spending And Medication Adherence Among Dialysis Patients In Twelve Countries

Hirth

Greer²,

Albert³

et al. 2008

Health Affairs

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Few studies have examined drug costs and adherence in similar patient cohorts across countries. Using representative samples of hemodialysis patients from twelve countries, we examined out-of-pocket medication spending and cost-related nonadherence. Mean monthly spending ranged from $8 in the United Kingdom to $114 in the United States. The proportion of patients reporting nonadherence because of cost ranged from 3 percent in Japan to 29 percent in the United States. Out-of-pocket spending was related to national pharmaceutical financing policies and predicted national nonadherence rates. However, inconsistencies in the relationship between patient costs and nonadherence suggested that other social or policy factors also matter.

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“…Hemodialysis facilities are randomly selected in each country according to factors, such as geographic location and facility setting or dialysis organization. Basic demographic information (age, sex, race, and years on dialysis) is collected for all facility patients, and a random sample of patients on hemodialysis is selected for DOPPS enrollment with expanded longitudinal data collection, including medical history, monthly laboratory values, vascular access history, and medication lists with dosing information (details of the study design are in the works by Young et al 39 and Pisoni et al 40 ).…”

Section: Data Sourcesmentioning

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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The Dialysis Outcomes and Practice Patterns Study (DOPPS): Design, data elements, and methodology

Cited by 206 publications

References 4 publications

Transfusion Burden among Patients with Chronic Kidney Disease and Anemia

Transfusion Burden among Patients with Chronic Kidney Disease and Anemia

Out-Of-Pocket Spending And Medication Adherence Among Dialysis Patients In Twelve Countries

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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