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Nephrol Dial Transplant (2004) 19: 121-132
© European Renal Association–European Dialysis and Transplant Association

Original Article

Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Francesco Locatelli1, Ronald L. Pisoni2, Christian Combe3, Juergen Bommer4, Vittorio E. Andreucci5, Luis Piera6, Roger Greenwood7, Harold I. Feldman8, Friedrich K. Port2 and Philip J. Held2

1Department of Nephrology and Dialysis, A Manzoni Hospital, Lecco, Italy, 2University Renal Research and Education Association, Ann Arbor, MI, USA, 3Nephrology and Hemodialysis Service, Hôpital St-André, Bordeaux, France, 4Nephrology Section, University of Heidelberg, Heidelberg, Germany, 5Department of Nephrology, Universita Federico II, Naples, Italy, 6Nephrology Service, Hospital General Vall d’Hebron, Barcelona, Spain, 7Department of Renal Medicine, Lister Hospital, Stevenage, UK and 8Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Correspondence and offprint requests to: Dr Friedrich K. Port, MD, MS, University Renal Research and Education Association, 315 W. Huron St., Suite 260, Ann Arbor, MI 48103, USA. Email: fport{at}urrea.org

Background. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study based on data collected from nationally representative samples of haemodialysis facilities. The burden of anaemia in haemodialysis patients is substantial, leading to considerable morbidity, mortality and reduced quality of life. This study examines anaemia management and outcomes based on data from five European countries participating in the DOPPS: France, Germany, Italy, Spain and the UK.

Methods. Baseline data on demographics, co-morbidities and anaemia management in 4591 haemodialysis patients from 101 nephrology facilities were collected in 1998–2000. Using multivariate Cox survival analyses to adjust for patient characteristics, relationships between haemoglobin concentration at study entry and rates of mortality and hospitalization were evaluated.

Results. For a year 2000 sample of prevalent patients on haemodialysis >180 days, mean haemoglobin concentration was 11.0 g/dl; 53% had a haemoglobin concentration >=11 g/dl [1998–1999 = 44% (P < 0.05)]. In 2000, 84% of prevalent patients were prescribed recombinant human erythropoietin (rHuEpo). Higher haemoglobin concentrations were associated with decreased relative risk (RR) for mortality (RR = 0.95 for every 1 g/dl higher haemoglobin, P = 0.03) and hospitalization (RR = 0.96, P = 0.02). Patients with haemoglobin <10 g/dl were 29% more likely to be hospitalized than patients with haemoglobin 11–12 g/dl (P < 0.001).

Conclusion. Even after adjustment, lower haemoglobin concentrations were associated with higher morbidity and mortality in European haemodialysis patients. A trend to increased haemoglobin concentrations was observed following publication of the European Best Practice Guidelines (EBPG) on anaemia management for chronic kidney disease patients, but efforts must continue to achieve EBPG goals.

Keywords: anaemia; chronic kidney disease; morbidity; mortality; haemodialysis; rHuEpo


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