Document Detail


Renal anemia: comparing current Eastern and Western European management practice (ORAMA).
MedLine Citation:
PMID:  18350446     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The Optimal Renal Anaemia Management Assessment trial prospectively examined the impact of implementing European Best Practice Guidelines on outcomes in the management of renal anemia. Baseline data give an insight to standards of clinical care and provide a basis for a future comparison of guideline target attainment with final results. Fifty-three centers from eight European countries enrolled 739 patients with stage II-V chronic kidney disease who were either anemic (hemoglobin <11 g/dL) or treated with erythropoiesis-stimulating agents and/or iron supplementation. Patients were followed over 6-8 months in centers that were randomly allocated to either group A or B (i.e., with or without a computerized clinical decision support tool after baseline). The latter provided guideline-based recommendations to physicians based on patient anemia-related data. We report patient characteristics and hemoglobin values from baseline and the prestudy period, focusing on regional differences. In all, 81% of patients were dialysis-dependent. Baseline mean hemoglobin values in dialysis patients were significantly higher in Western (11.8 g/dL) vs. Eastern Europe (10.6 g/dL; p < 0.0001). Similar proportions of patients (approximately 50%) had mean hemoglobin 10-12 g/dL suggesting Eastern European patients are treated to lower Hb levels. The guideline ferritin target was achieved by 85% of dialysis and 52% of non-dialysis patients; 81% of dialysis and 78% of non-dialysis patients attained the transferrin saturation target. Most patients (96%) were receiving erythropoiesis-stimulating agents. Anemia management in patients with chronic kidney disease shows considerable regional differences across Europe, and target attainment remains suboptimal in many European nephrology centers after the revised 2004 guidelines.
Authors:
Andrzej Wiecek; Adrian Covic; Francesco Locatelli; Iain C Macdougall;
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Renal failure     Volume:  30     ISSN:  1525-6049     ISO Abbreviation:  Ren Fail     Publication Date:  2008  
Date Detail:
Created Date:  2008-03-19     Completed Date:  2008-06-11     Revised Date:  2008-07-21    
Medline Journal Info:
Nlm Unique ID:  8701128     Medline TA:  Ren Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  267-76     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Francuska, Poland. awiecek@spskm.katowice.pl
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anemia / drug therapy*,  etiology
Case-Control Studies
Decision Support Systems, Clinical
Europe, Eastern
Female
Ferritins / blood
Guideline Adherence*
Hemoglobins / metabolism
Humans
Kidney Failure, Chronic / blood,  complications*
Male
Middle Aged
Outcome Assessment (Health Care)*
Physician's Practice Patterns
Practice Guidelines as Topic*
Prospective Studies
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Hemoglobins; 9007-73-2/Ferritins
Investigator
Investigator/Affiliation:
Peter Shikov / ; Dimitar Nikolov / ; Boriana Deliyska / ; Dobrin Paskalev / ; Pencho Simeonov / ; Zarko Belavic / ; Barbic Jerko / ; Ninoslov Leko / ; Ivan Bogadi / ; Roland E Winkler / ; Martin Buhl / ; Eckhard Wilbrandt / ; Martin Edinger / ; Margit Mall / ; Christoph Dammerboer / ; Holger Urzowski / ; Daniela Flender / ; Gabriele Kunowski / ; Alexander Müller / ; Hans Anschütz / ; Gerhard Prager / ; Johann-Borwin / ; Natale Gaspare De Santo / ; Cosimo Lodeserto / ; Mario Bonomini / ; Gina Meneghel / ; Mauro Ragaiolo / ; Giovanni Cancarini / ; Ugo Rotolo / ; L Zepa / ; G Saumane-Baza / ; G Ritovs / ; R Rozentals / ; Andrezej Rydzewski / ; Danuta Antczak-Jedrzejczak / ; Wlodzimierz Ratajewski / ; Dorata Frankiewicz / ; Olech Mazur / ; Bogdanowicz Grazyna / ; Kosicki Andrezej / ; Sydor Antoni / ; Muszytowski Marek / ; Gabriel Mircescu / ; Marina Mugosa Ratkovic / ; Steva Pljesa / ; Vidosava Nesic / ; Nada Dimkovic / ; Svobodan Curic / ; Marina Lazarevic / ; Zoran Kovacevic /

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