Document Detail


Individualized anemia management reduces hemoglobin variability in hemodialysis patients.
MedLine Citation:
PMID:  24029429     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
One-size-fits-all protocol-based approaches to anemia management with erythropoiesis-stimulating agents (ESAs) may result in undesired patterns of hemoglobin variability. In this single-center, double-blind, randomized controlled trial, we tested the hypothesis that individualized dosing of ESA improves hemoglobin variability over a standard population-based approach. We enrolled 62 hemodialysis patients and followed them over a 12-month period. Patients were randomly assigned to receive ESA doses guided by the Smart Anemia Manager algorithm (treatment) or by a standard protocol (control). Dose recommendations, performed on a monthly basis, were validated by an expert physician anemia manager. The primary outcome was the percentage of hemoglobin concentrations between 10 and 12 g/dl over the follow-up period. A total of 258 of 356 (72.5%) hemoglobin concentrations were between 10 and 12 g/dl in the treatment group, compared with 208 of 336 (61.9%) in the control group; 42 (11.8%) hemoglobin concentrations were <10 g/dl in the treatment group compared with 88 (24.7%) in the control group; and 56 (15.7%) hemoglobin concentrations were >12 g/dl in the treatment group compared with 46 (13.4%) in the control group. The median ESA dosage per patient was 2000 IU/wk in both groups. Five participants received 6 transfusions (21 U) in the treatment group, compared with 8 participants and 13 transfusions (31 U) in the control group. These results suggest that individualized ESA dosing decreases total hemoglobin variability compared with a population protocol-based approach. As hemoglobin levels are declining in hemodialysis patients, decreasing hemoglobin variability may help reduce the risk of transfusions in this population.
Authors:
Adam E Gaweda; George R Aronoff; Alfred A Jacobs; Shesh N Rai; Michael E Brier
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2013-09-12
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  25     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-01-01     Completed Date:  2014-02-25     Revised Date:  2014-05-19    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  159-66     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Algorithms
Anemia / blood,  etiology*,  therapy*
Double-Blind Method
Erythrocyte Transfusion
Female
Hematinics / administration & dosage*
Hemoglobins / metabolism*
Humans
Individualized Medicine
Kidney Failure, Chronic / blood,  complications*,  therapy*
Male
Middle Aged
Renal Dialysis*
Grant Support
ID/Acronym/Agency:
1R01DK093832/DK/NIDDK NIH HHS; 5K25DK72085/DK/NIDDK NIH HHS; K25 DK072085/DK/NIDDK NIH HHS; R01 DK093832/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Hematinics; 0/Hemoglobins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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