Maintaining over time Clinical Performance targets on Anaemia correction in unselected population on chronic dialysis at 20 Italian Centres. Data from a retrospective study for a Clinical AuditReport as inadecuate




Maintaining over time Clinical Performance targets on Anaemia correction in unselected population on chronic dialysis at 20 Italian Centres. Data from a retrospective study for a Clinical Audit - Download this document for free, or read online. Document in PDF available to download.

BMC Nephrology

, 10:33

First Online: 24 October 2009Received: 02 January 2009Accepted: 24 October 2009

Abstract

BackgroundThe Italian and European Best Practice Guidelines EBPG recommend a target haemoglobin value greater than 11 g-dl in most patients with Chronic Kidney Diseases. However, it is still difficult to maintain these values at a steady rate. Thus, the main aim of the study was to evaluate, throughout 2005, how many patients steadily maintained the performance targets related to anaemia treatment.

MethodsThe survey was conducted on 3283 patients on haemodialysis HD and peritoneal dialysis PD at 20 Italian dialysis centres. 540 patients were randomly selected; each centre provided a statistically significant sample proportional to its total number of patients. Maintenance of the following target levels was assessed over time: Haemoglobin HB 11-12 gr-dl; Iron: 60-160 mcg-dl; Ferritin: 30-400 mcg-l; Transferrin: 200-360 mg-dl; Transferrin saturation percentage TSAT %:> 25 <50; Dialysis doses KT-V: >1.2 <2.0 for non-diabetic HD patients; >1.5 <2.2 for diabetic HD patients; DP: >1.8 <2.5.

Outcome included:

1- Percentage of target maintenance for each parameter.

2- Erythropoietin dose in relation to dialysis techniques, presence of cancer or myeloma, diabetic status, Vitamin B therapy.

3- Erythropoietin dose International Units-kg-week IU-kg-wk depending on: haemoglobin values, hospitalization of more than 3 days.

ResultsMean age was 65.1; mean haemoglobin concentration over the whole population was 11.3 gr-dl Standard Deviation SD: 0.91. The clinical performance targets were maintained over time as follows: HB: 4.3% Mean 11.43 gr-dl SD: 0.42; Ferritin: 71.1% Mean: 250.23 mcg-L SD:104.07; Iron: 95.0% Mean 59.79 mcg-dlSD:16.76; Transferrin: 44.8% Mean 216.83 mg-dl SD: 19,50; TSAT %: in 8.4% Mean: 34.33% SD: 6.56; HD KT-V: 61.0% Mean:1.46 SD: 0.7; PD KT-V:31.4% Mean: 2.10 SD: 0.02. The average weekly dose of Erythropoietin IU-Kg-Wk was significantly lower for the peritoneal dialysis technique; the higher haemoglobin values, the lower the Erythropoietin dose IU-Kg-Wk.

ConclusionA very low percentage of patients maintained haemoglobin target values over time. We need to identify precise criteria to evaluate the stability over time of clinical performance targets proposed by the guidelines.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-10-33 contains supplementary material, which is available to authorized users.

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Author: Silvia Soffritti - Giorgia Russo - Stefano Cantelli - Giuseppe Gilli - Luigi Catizone

Source: https://link.springer.com/







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