scholarly journals Evaluating the effectiveness of IV iron dosing for anemia management in common clinical practice: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)

2017 ◽  
Vol 18 (1) ◽  
Author(s):  
Bruce M. Robinson ◽  
Maria Larkina ◽  
Brian Bieber ◽  
Werner Kleophas ◽  
Yun Li ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Practice Patterns ◽  
Anemia Management ◽  
Iv Iron ◽  
Common Clinical Practice ◽  
Dialysis Outcomes

International Anemia Prevalence and Management in Peritoneal Dialysis Patients

2019 ◽  
Vol 39 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Rachel L. Perlman ◽  
Junhui Zhao ◽  
Douglas S. Fuller ◽  
Brian Bieber ◽  
Yun Li ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
The United States ◽  
Clinical Practices ◽  
Dialysis Patients ◽  
The Us ◽  
Anemia Management ◽  
Iv Iron ◽  
Dialysis Outcomes

Background The optimal treatment for managing anemia in peritoneal dialysis (PD) patients and best clinical practices are not completely understood. We sought to characterize international variations in anemia measures and management among PD patients. Methods The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) enrolled adult PD patients from 6 countries from 2014 to 2017. Hemoglobin (Hb), ferritin levels, and transferrin saturation (TSAT), as well as erythropoiesis stimulating agents (ESAs) and iron use were compared cross-sectionally at study enrollment in Australia and New Zealand (A/NZ), Canada, Japan, the United Kingdom (UK), and the United States (US). Results Among 3,603 PD patients from 193 facilities, mean Hb ranged from 11.0 – 11.3 g/dL across countries. The majority of patients (range 53% – 59%) had Hb 10 – 11.9 g/dL, with 4% – 12% patients ≥ 13 g/dL and 16% – 23% < 10 g/dL. Use of ESAs was higher in Japan (94% of patients) than elsewhere (66% – 79% of patients). In the US, 63% of patients had a ferritin level > 500 ng/mL, compared with 5% – 38% in other countries. In the US and Japan, 87% – 89% of PD patients had TSAT ≥ 20%, compared with 73% – 76% in other countries. Intravenous (IV) iron use within 4 months of enrollment was higher in the US (55% of patients) than elsewhere (6% – 17% patients). Conclusions In this largest international observational study of anemia and anemia management in patients receiving PD, comparable Hb levels across countries were observed but with notable differences in ESA and iron use. Peritoneal dialysis patients in the US have higher ferritin levels and higher IV iron use than other countries.

Anemia management and outcomes from 12 countries in the dialysis outcomes and practice patterns study (DOPPS)

2004 ◽  
Vol 44 (1) ◽  
pp. 94-111 ◽  
Author(s):  
Ronald L Pisoni ◽  
Jennifer L Bragg-Gresham ◽  
Eric W Young ◽  
Tadao Akizawa ◽  
Yasushi Asano ◽  
...  
Keyword(s):  
Practice Patterns ◽  
Anemia Management ◽  
Dialysis Outcomes

scholarly journals Low hemoglobin at hemodialysis initiation: an international study of anemia management and mortality in the early dialysis period

2019 ◽  
Vol 13 (3) ◽  
pp. 425-433
Author(s):  
Angelo Karaboyas ◽  
Hal Morgenstern ◽  
Sandra Waechter ◽  
Nancy L Fleischer ◽  
Raymond Vanholder ◽  
...  
Keyword(s):  
International Study ◽  
First Year ◽  
Advanced Chronic Kidney Disease ◽  
Proactive Approach ◽  
Anemia Management ◽  
Iv Iron ◽  
High Doses ◽  
Dialysis Outcomes ◽  
Higher Doses

Abstract Background Anemia at hemodialysis (HD) initiation is common. Correcting low hemoglobin (Hgb) before HD initiation may improve survival by avoiding potential harms of chronic anemia, high doses of erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron in the early HD period, and/or rapid Hgb rise. Methods We included 4604 incident HD patients from 21 countries in the Dialysis Outcomes and Practice Patterns Study Phases 4–5 (2009–15). Because low Hgb at HD start may reflect comorbidity or ESA hyporesponse, we restricted our analysis to the 80% of patients who achieved Hgb ≥10 g/dL 91–120 days after HD start (Month 4). Results About 53% of these patients had Hgb &lt;10 g/dL in Month 1 (&lt;30 days after HD start); they were younger with a similar comorbidity profile (versus Hgb ≥10 g/dL). Month 1 Hgb was associated with first-year HD mortality (adjusted hazard ratio for 1 g/dL higher Hgb was 0.89; 95% confidence interval: 0.81–0.97), despite minimal differences in Month 4 Hgb. Patients with lower Hgb in Month 1 received higher doses of ESA, but not IV iron, over the first 3 months of HD. Results were consistent when excluding catheter users or adjusting for IV iron and ESA dose over the first 3 months. Conclusions Even among patients with Hgb ≥10 g/dL 3 months later, anemia at HD initiation was common and associated with elevated mortality. A more proactive approach to anemia management in advanced chronic kidney disease (CKD) may thus improve survival on HD, though long-term prospective studies of non-dialysis CKD patients are needed.

scholarly journals Clinical Practice Patterns of Fitting Advanced Device Features in Children With Cochlear Implants

2022 ◽  
pp. 1-19
Author(s):  
Ursula M. Findlen ◽  
Jason Benedict ◽  
Smita Agrawal
Keyword(s):  
Clinical Practice ◽  
Cochlear Implants ◽  
Mixed Model ◽  
Practice Patterns ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Clinical Practice Patterns ◽  
Directional Microphones ◽  
Common Clinical Practice ◽  
Noise Management

Purpose: The purpose of this study was to identify common clinical practice patterns for providing advanced noise management features in children with cochlear implants (CIs) and evaluate trends in consideration of clinician experience and comfort with CI manufacturer-specific technology. Method: A mixed-model survey including quantitative and qualitative questions regarding providing advanced noise management features in the pediatric CI population was collected electronically via research electronic data capture. Survey questions spanned approach/philosophy toward provision of features, age of provision, and demographics of respondents. Descriptive statistics were completed to define common clinical practice patterns and demographic information. Results: A total of 160 pediatric audiologists from 35 U.S. States and five Canadian provinces completed the survey. Most audiologists (73.8%) reported enabling automatic directional microphones, and a vast majority (91%) reported enabling advanced noise processing features such as automatic noise cancellers, wind noise cancellers, and impulse noise cancellers in recipients' main programs. Audiologists ranked features in terms of importance for a school-age child with the top three ranked as automatic noise reduction, automatic directional microphones, and concha-level microphones. Importance of child-specific factors varied depending upon the specific feature of interest. Conclusions: Variability exists among providers in enabling advanced noise management features for pediatric CI recipients. Multiple factors, including patient characteristics, provider characteristics, and limited evidence-based guidance, could account for much of the variation. Overall, there is a trend toward automaticity for noise management. Additional studies are warranted to provide the evidence base for confidently programming advanced features for children using CIs.

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