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

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

Research output: Contribution to journalReview articlepeer-review

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)
Pages (from-to)S5-S11
JournalAmerican Journal of Kidney Diseases
Volume34
Issue number4 SUPPL. 2
DOIs
StatePublished - 1999

Keywords

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

ASJC Scopus subject areas

  • Nephrology

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