Treatment and costs associated with anemic chronic kidney disease patients

Rasu, Rafia S.; Crawford, Tonya; Manley, Harold J.; Balkrishnan, Rajesh

doi:10.1185/030079907x242782

Cited by 2 publications

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“… 14 – 19 Polypharmacy was a vital component to be looked at as evidence showed that treating patients with multiple medications, ie, polypharmacy, can adversely affect patient outcomes. 14 – 16 , 19 , 21 – 23 …”

Section: Methodsmentioning

confidence: 99%

Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh

Rasu¹,

Iqbal²,

Hanifi³

et al. 2014

CEOR

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ObjectiveVillage doctors, informal health care providers practicing modern medicine, are dominant health care providers in rural Bangladesh. Given their role, it is important to examine their prescription pattern and inappropriate use of medication.MethodsThese cross-sectional study data were collected through surveys of patients seen by village doctors during 2008 and 2010 at Chakaria, a typical rural area of Bangladesh. Categorization of appropriate, inappropriate, and harmful prescriptions by disease conditions was based on guidelines defined by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the Government of Bangladesh. Analytical categorization of polypharmacy was defined when five or more medications were prescribed for a patient at a single visit.FindingsA total of 2,587 prescriptions were written by village doctors during the survey periods. Among the prescriptions were appropriate (10%), inappropriate (8%), combination of appropriate and inappropriate (63%), and harmful medications (19%). Village doctors with more than high school education were 53% less likely (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.26–0.86) to give polypharmacy prescriptions than those with less than high school education. While exploring determinants of prescribing inappropriate and harmful medications, this study found that polypharmacy prescriptions were six times more likely [OR: 6.00, 95% CI: 3.88–9.29] to have harmful medications than prescriptions with <5 medications.ConclusionVillage doctors’ training and supervision may improve the quality of services and establish accountability for the benefit of the rural population.

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Section: Methodsmentioning

confidence: 99%

Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh

Rasu¹,

Iqbal²,

Hanifi³

et al. 2014

CEOR

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“…A final relevant consideration is that nephrologists have greater experience in managing ESAs and the iron status of their patients. Increasing iron storage and availability has a positive impact on the attainment of Hb targets with erythropoietin, although the risk for hemosiderosis should be considered [38].…”

Section: Experience In Managing Iron Statusmentioning

confidence: 99%

Is Nephrology More at Ease Than Oncology with Erythropoiesis-Stimulating Agents? Treatment Guidelines and an Update on Benefits and Risks

Locatelli

Gascón

2009

The Oncologist

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Erythropoiesis-stimulating agents (ESAs), which promote RBC production, have been extensively used to reduce transfusion requirements and improve quality of life (QoL) in both cancer patients and those with chronic kidney disease (CKD). However, the likelihood of response and duration of treatment differ in the two settings. In renal anemia, ESAs act straightforwardly as hormone-replacement therapy. The anemia of cancer, however, relates not to a lack of endogenous erythropoietin production but to diverse aspects of the disease (including a relevant inflammatory component) and chemotherapy. Response to ESAs is slower and less certain than in nephrology. In both settings, early studies showed that reversal of severe anemia was accompanied by substantial improvement in QoL. However, again in both settings, subsequent studies indicated that efforts to normalize hemoglobin might worsen outcome. In the context of cancer, this concern was reinforced by the suggestion that malignant cells had erythropoietin receptors and that its administration might therefore accelerate tumor growth, and moreover that cancer patients are more susceptible to venous thrombosis. The absence of these concerns for nephrologists, and their greater experience in managing ESAs and patients' iron status, may make them more at ease with ESAs than their counterparts in oncology. However, both groups of specialists have had to deal with reversals in recommended thresholds for intervention and restrictions imposed by regulatory authorities. In both specialties, the broad consensus now emerging is that the optimum balance of benefits and risks lies in using ESAs aimed at a hemoglobin level in the range of 11-12 g/dl, although for CKD patients there is still room for an individualized approach. The Oncologist 2009;14(suppl 1):57-62

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Treatment and costs associated with anemic chronic kidney disease patients

Cited by 2 publications

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Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh

Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh

Is Nephrology More at Ease Than Oncology with Erythropoiesis-Stimulating Agents? Treatment Guidelines and an Update on Benefits and Risks

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