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Table of Contents
Vol. 108, No. 1, 2008
Issue release date: February 2008
Section title: Original Paper
Nephron Clin Pract 2008;108:c67–c74
(DOI:10.1159/000112914)

Evaluation and Determinants of Underprescription of Erythropoiesis Stimulating Agents in Pre-Dialysis Patients with Anaemia

Thilly N.a · Stengel B.b · Boini S.a · Villar E.c · Couchoud C.d · Frimat L.e
aDepartment of Clinical Epidemiology and Evaluation, CEC-CIE6 Inserm, University Hospital of Nancy, EA4003, Nancy University, Nancy, bInserm U780, Research in Epidemiology and Biostatistics, Villejuif, cDepartment of Nephrology and Renal Transplantation and Department of Biostatistics, UMR CNRS 5558, Hospices Civils de Lyon, Lyon-Sud Academic Hospital, Pierre Bénite, dREIN Registry, Agence de la Biomédecine, La Plaine Saint Denis, and eDepartment of Nephrology, Hôpitaux de Brabois, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: April 17, 2007
Accepted: August 14, 2007
Published online: January 08, 2008
Issue release date: February 2008

Number of Print Pages: 1
Number of Figures: 1
Number of Tables: 3

ISSN: (Print)
eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC

Abstract

Background: Inadequate anaemia correction (haemoglobin (Hb) <11 g/dl without receiving an erythropoiesis-stimulating agent (ESA) is common in pre-dialysis patients, but little is known about its determinants. We used data from the French end-stage renal disease (ESRD) registry to investigate these determinants and the patients’ anaemia status 1 year after starting dialysis. Methods: Pre-dialysis anaemia care was studied in 6,271 incident ESRD patients from 13 regions, who were first treated between 2003 and 2005. Data included pre-dialysis Hb measure and ESA use, patient’s condition and modalities of dialysis initiation. Anaemia status at 1 year was studied in 925 patients from four regions who started dialysis in 2003 and 2004, were still on dialysis one year later, and had completed the annual registry data form. Results: Overall, 34.7% of the patients had inadequate pre-dialysis anaemia correction, with variations across regions from 21.1 to 43.2%. Inadequate anaemia correction decreased from 38.0% in 2003 to 33.2% in 2005. It was less likely in patients with diabetic or polycystic kidney disease and more likely in those with malignancy, unplanned haemodialysis, and low glomerular filtration rate or low serum albumin at dialysis initiation. One year after starting dialysis, inadequate correction concerned only 2.6% of the patients. Hb level had risen from 10.3 g/dl in pre-dialysis to 11.7 g/dl, but remained lower in those with inadequate pre-dialysis correction. Conclusion: Despite improvement over time, inadequate correction with ESAs remains high in pre-dialysis patients in contrast with those on dialysis. As the timing of dialysis initiation is uncertain, continuous management of anaemia is requested.

© 2008 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: April 17, 2007
Accepted: August 14, 2007
Published online: January 08, 2008
Issue release date: February 2008

Number of Print Pages: 1
Number of Figures: 1
Number of Tables: 3

ISSN: (Print)
eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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