National perspective on iron therapy as a clinical performance measure for maintenance hemodialysis patients

Jr Owen W.F., L. Szczech, C. Johnson, D. Frankenfield

Research output: Contribution to journalArticle

Abstract

The Health Care Financing Administration (HCFA) End-Stage Renal Disease (ESRD) Core Indicators Project collects clinical information on prevalent adult patients receiving in-center hemodialysis care in the United States to assess the quality of care delivered. Although hematocrit values, transferrin saturations (TSATs) and iron prescription practices have improved over the last 5 years, we sought to determine whether there are continued opportunities for improvement of this domain of care. A random sample of 7,292 adult in-center hemodialysis patients was selected for the period October through December 1996. Hematocrit values, TSATs, serum ferritin concentrations, epoetin-alfa dosing, and iron prescriptions were abstracted from 4,991 patient medical records to assess anemia management practices. The mean hematocrit for this cohort was 32.6% ± 3.5%, and 72% of patients had hematocrit values greater than 30%. Ninety-four percent of patients received epoetin alfa intravenously, with a mean weekly epoetin dose of 202.4 ± 137.2 U/kg. The mean TSAT was 27.4% ± 12.6%; 73% of patients had TSATs 20%. The mean serum ferritin concentration was 386 ± 422 ng/mL; 79% and 12% of patients had serum ferritin concentrations greater than 100 ng/mL and greater than 800 ng/mL, respectively. Nine percent of the sample had TSATs less than 20% and serum ferritin concentrations less than 100 ng/mL. Regardless of the TSAT, approximately three fourths of patients received iron; only about half received IV iron. Of the subset of patients with TSATs less than 20% and serum ferritin concentration less than 800 ng/mL, only 53% were prescribed IV iron. Although substantial improvements have been made in anemia management in hemodialysis patients over the last 5 years, significant opportunities persist to improve iron prescription practices.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
Volume34
Issue number4 SUPPL. 2
StatePublished - 1999
Externally publishedYes

Fingerprint

Renal Dialysis
Iron
Maintenance
Transferrin
Ferritins
Epoetin Alfa
Hematocrit
Prescriptions
Therapeutics
Serum
Anemia
Centers for Medicare and Medicaid Services (U.S.)
Quality of Health Care
Practice Management
Chronic Kidney Failure
Medical Records

Keywords

  • Hematocrit
  • Hemodialysis
  • Iron-deficiency anemia
  • Kidney failure
  • Quality of health care

ASJC Scopus subject areas

  • Nephrology

Cite this

National perspective on iron therapy as a clinical performance measure for maintenance hemodialysis patients. / Owen W.F., Jr; Szczech, L.; Johnson, C.; Frankenfield, D.

In: American Journal of Kidney Diseases, Vol. 34, No. 4 SUPPL. 2, 1999.

Research output: Contribution to journalArticle

Owen W.F., Jr ; Szczech, L. ; Johnson, C. ; Frankenfield, D. / National perspective on iron therapy as a clinical performance measure for maintenance hemodialysis patients. In: American Journal of Kidney Diseases. 1999 ; Vol. 34, No. 4 SUPPL. 2.
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