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Trends in Hemoglobin, EPO, and Iron Dose in Hemodialysis Patients

This study examines the trends in hemoglobin levels, erythropoietin (EPO) dose, and iron dose in incident and prevalent hemodialysis patients. It analyzes data from the first 6 months of therapy and explores the relationship between these variables and factors like age, gender, race/ethnicity, and modality.

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Trends in Hemoglobin, EPO, and Iron Dose in Hemodialysis Patients

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  1. Hemoglobin, EPO, & Iron dosefigure 4.1 period prevalent hemodialysis patients

  2. Mean monthly hemoglobin at initiation of therapy & in the first 6 months of ESRDfigure 4.2, incident hemodialysis patients

  3. Mean EPO dose per week after initiation of & in the first 6 months of ESRDfigure 4.3, incident hemodialysis patients

  4. Percent of patients receiving iron at initiation of therapy & in the first 6 months of ESRDfigure 4.4, incident hemodialysis patients

  5. Mean monthly hemoglobin by initial Hb from the ME formfigure 4.5, incident dialysis patients, 1995-2000 combined

  6. Mean EPO dose per week by initial Hb from the ME formfigure 4.6, incident dialysis patients, 1995-2000 combined

  7. Percentage of patients receiving iv iron by initial Hb from the ME formfigure 4.7, incident dialysis patients, 1995-2000 combined

  8. Prevalent patient counts, by data sourcetable 4.a, point prevalent ESRD patients; only patients with data in both databases

  9. Prevalent patient counts, by data sourcetable 4.a, point prevalent ESRD patients; only patients with data in both databases (cont.)

  10. Trends in mean hemoglobin, by modality, iron use, data source, & EPO usefigure 4.8

  11. Trends in mean hemoglobin, by modality, iron use, data source, & EPO usefigure 4.8 (cont.)

  12. Trends in mean EPO dose per week, by modality, iron use, & data sourcefigure 4.9

  13. Trends in mean EPO dose per week, by modality, iron use, & data sourcefigure 4.9 (cont.)

  14. Trends in mean hemoglobin, by modality, age, gender, & race/ethnicityfigure 4.10, period prevalent dialysis patients

  15. Trends in mean EPO dose per week, by modality, age, gender, & race/ethnicityfigure 4.11, period prevalent dialysis patients

  16. Trends in mean hemoglobin, by modality, age, gender, & race/ethnicityfigure 4.10, period prevalent dialysis patients

  17. Trends in mean hemoglobin, by modality, age, gender, & race/ethnicityfigure 4.10, period prevalent dialysis patients (cont.)

  18. Trends in mean EPO dose per week, by modality, age, gender, & race/ethnicityfigure 4.11, period prevalent dialysis patients

  19. Trends in mean EPO dose per week, by modality, age, gender, & race/ethnicityfigure 4.11, period prevalent dialysis patients (cont.)

  20. Trends in patient distribution, by mean monthly hemoglobinfigure 4.12, period prevalent dialysis patients 100 13+ 12.5-<13 80 12-<12.5 s t 60 en ti 11-<12 a p f o t 40 en rc e P 10-<11 20 <10 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

  21. Trends in patient distribution, by rolling three-month mean hemoglobinfigure 4.13, period prevalent dialysis patients 100 13+ 12.5-<13 80 12-<12.5 s t 60 11-<12 en ti a p f o t 40 en rc e P 10-<11 20 <10 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

  22. Trends in mean monthly hemoglobin & mean EPO dose per weekfigure 4.14, period prevalent dialysis patients

  23. Mean hemoglobin: hemodialysisfigure 4.15, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean hemoglobin (g/dl) 11.69+ (11.87) 11.57 to <11.69 11.45 to <11.57 11.30 to <11.45 below 11.30 (11.11)

  24. Mean EPO dose: hemodialysisfigure 4.16, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean weekly EPO dose 17,030+ (19,707) 15,270 to <17,030 13,880 to <15,270 12,120 to <13,880 below 12,120 (9,976)

  25. Mean hemoglobin, all-cause infections:no infectionsfigure 4.17, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean hemoglobin (g/dl) 11.79+ (12.00) 11.64 to <11.79 11.52 to <11.64 11.36 to <11.52 below 11.36 (11.10)

  26. Mean hemoglobin, all-cause infections:1-2 infectionsfigure 4.17, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean hemoglobin (g/dl) 11.79+ (12.04) 11.64 to <11.79 11.52 to <11.64 11.36 to <11.52 below 11.36 (11.04)

  27. Mean hemoglobin, all-cause infections:2-3 infectionsfigure 4.17, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean hemoglobin (g/dl) 11.79+ (12.08) 11.64 to <11.79 11.52 to <11.64 11.36 to <11.52 below 11.36 (10.97)

  28. Mean hemoglobin, all-cause infections:3-5 infectionsfigure 4.17, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean hemoglobin (g/dl) 11.79+ (12.20) 11.64 to <11.79 11.52 to <11.64 11.36 to <11.52 below 11.36 (10.79)

  29. Mean hemoglobin, all-cause infections:5+ infectionsfigure 4.17, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean hemoglobin (g/dl) 11.79+ (12.34) 11.64 to <11.79 11.52 to <11.64 11.36 to <11.52 below 11.36 (10.53)

  30. Mean hemoglobin, all-cause infections:at least 1 infectionfigure 4.17, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean hemoglobin (g/dl) 11.79+ (12.10) 11.64 to <11.79 11.52 to <11.64 11.36 to <11.52 below 11.36 (11.02)

  31. Mean weekly EPO dose, all-cause infections: no infectionsfigure 4.18, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean EPO dose 16,330+ (19,026) 14,590 to <16,330 13,250 to <14,590 11,550 to <13,250 below 11,550 (9,402)

  32. Mean weekly EPO dose, all-cause infections: 1-2 infectionsfigure 4.18, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean EPO dose 16,330+ (20,759) 14,590 to <16,330 13,250 to <14,590 11,550 to <13,250 below 11,550 (8,305)

  33. Mean weekly EPO dose, all-cause infections: 2-3 infectionsfigure 4.18, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean EPO dose 16,330+ (21,947) 14,590 to <16,330 13,250 to <14,590 11,550 to <13,250 below 11,550 (8,044)

  34. Mean weekly EPO dose, all-cause infections: 3-5 infectionsfigure 4.18, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean EPO dose 16,330+ (22,375) 14,590 to <16,330 13,250 to <14,590 11,550 to <13,250 below 11,550 (8,144)

  35. Mean weekly EPO dose, all-cause infections: 5+ infectionsfigure 4.18, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean EPO dose 16,330+ (22,235) 14,590 to <16,330 13,250 to <14,590 11,550 to <13,250 below 11,550 (7,891)

  36. Mean weekly EPO dose, all-cause infections: at least 1 infectionfigure 4.18, period prevalent hemodialysis patients, 2000, by HSA, unadjusted Mean EPO dose 16,330+ (20,287) 14,590 to <16,330 13,250 to <14,590 11,550 to <13,250 below 11,550 (8,542)

  37. Mean hemoglobin & mean EPO dose per week: all-cause infectionsfigure 4.19, period prevalent hemodialysis patients age 20+, 2000

  38. Mean hemoglobin & mean EPO dose per week: all-cause infectionsfigure 4.19, period prevalent hemodialysis patients age 20+, 2000 (cont.) Number of inpatient hospital stays, per patient year at risk, with infection as the principal diagnosis All · All patients, regardless of status 1+ · Patients with at least one stay during year A · Patients with no stays B · Patients with 1–<2 stays C · Patients with 2–<3 stays D · Patients with 3–<5 stays E · Patients with five or more stays

  39. Mean hemoglobin & mean EPO dose per week: catheter infectionsfigure 4.20, period prevalent hemodialysis patients age 20+, 2000

  40. Mean hemoglobin & mean EPO dose per week: catheter infectionsfigure 4.20, period prevalent hemodialysis patients age 20+, 2000 (cont.) Number of inpatient hospital stays, per patient year at risk, with infection as the principal diagnosis All · All patients, regardless of status 1+ · Patients with at least one stay during year A · Patients with no stays B · Patients with 1–<2 stays C · Patients with 2–<3 stays D · Patients with 3–<5 stays E · Patients with five or more stays

  41. Mean hemoglobin & mean EPO dose per week: catheter insertionsfigure 4.21, period prevalent hemodialysis patients age 20+, 2000

  42. Mean hemoglobin & mean EPO dose per week: catheter insertionsfigure 4.21, period prevalent hemodialysis patients age 20+, 2000 (cont.) Number of catheter (temporary & permanent) insertions per patient year All · All patients, regardless of status 1+ · Patients with at least one insertion during year a · Patients with no insertions b · Patients with 1 insertion c · Patients with >1–2 insertions d · Patients with >2–3 insertions e · Patients with three or more insertions

  43. Distribution of median URR, by data sourcefigure 4.22

  44. Distribution of median URR, by gender (claims data)figure 4.23, period prevalent hemodialysis patients

  45. Geographic variations in the % of patients meeting the K/DOQI target URR of 65%: 1998figure 4.24, period prevalent hemodialysis patients, by HSA, unadjusted Percent of patients 87.1+ (89.2) 86.1 to <87.1 85.3 to <86.1 84.0 to <85.3 below 84.0 (81.1)

  46. Geographic variations in the % of patients meeting the K/DOQI target URR of 65%: 1999figure 4.24, period prevalent hemodialysis patients, by HSA, unadjusted Percent of patients 87.1+ (89.0) 86.1 to <87.1 85.3 to <86.1 84.0 to <85.3 below 84.0 (82.7)

  47. Geographic variations in the % of patients meeting the K/DOQI target URR of 65%: 2000figure 4.24, period prevalent hemodialysis patients, by HSA, unadjusted Percent of patients 87.1+ (88.8) 86.1 to <87.1 85.3 to <86.1 84.0 to <85.3 below 84.0 (83.3)

  48. Geographic variations in the % of pts meeting the K/DOQI target URR of 65%: % change, 1998-2000figure 4.24, period prevalent hemodialysis patients, by HSA, unadjusted Percent change, 1998-2000 7.45+ (9.98) 5.76 to <7.45 4.22 to <5.76 2.52 to <4.22 below 2.52 (1.24)

  49. Median URR, by unit characteristics: hemodialysis patientsfigure 4.25, period prevalent hemodialysis patients, claims data, 2000

  50. Trends in mean weekly Kt/V, by unit characteristics: peritoneal dialysis patientsfigure 4.26, CPM data

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