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NDT Advance Access originally published online on June 24, 2008
Nephrology Dialysis Transplantation 2008 23(11):3643-3653; doi:10.1093/ndt/gfn346
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Japanese haemodialysis anaemia management practices and outcomes (1999–2006): results from the DOPPS

Tadao Akizawa1, Ronald L. Pisoni2, Takashi Akiba3, Akira Saito4, Shunichi Fukuhara5, Yasushi Asano6, Takeshi Hasegawa5,7, Friedrich K. Port2 and Kiyoshi Kurokawa8

1 Division of Nephrology, Showa University School of Medicine, Tokyo, Japan 2 Arbor Research Collaborative for Health, Ann Arbor, MI, USA 3 Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo 4 Department of Internal Medicine and Institute of Medical Science, Tokai University School of Medicine, Isehara, Kanagawa 5 Department of Epidemiology and Healthcare Research, Graduate School of Medicine, Kyoto University, Kyoto 6 Department of Internal Medicine, Jichi Medical School and Koga Red Cross Hospital, Ibaragi 7 Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 8 The Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan

Correspondence and offprint requests to: Tadao Akizawa, Division of Nephrology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa, Tokyo 142-8666, Japan. Tel: +81-3-3784-8686; Fax: +81-3-3784-3751; E-mail: akizawa{at}med.showa-u.ac.jp



  Abstract

Background. Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients.

Methods. Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients.

Results. From 1999 to 2006, patient mean Hb increased from 9.7 g/dl to 10.4 g/dl, and the percentage of facilities with median Hb ≥10 g/dl increased from 27% to 75%. Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83% of HD patients; mean Epo dose was 5231 units/week; intravenous (IV) iron use was 33% and median IV iron dose was 160 mg/month. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR = 0.89 per 1 g/dl higher Hb, P = 0.003). Facilities with median Hb ≥10.4 displayed a lower mortality risk (RR = 0.77, P = 0.03) versus facility median Hb <10.4 g/dl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores.

Conclusions. These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide.

Keywords: anaemia; DOPPS; hospitalization; mortality; quality of life

Received for publication: 3. 7.07
Accepted in revised form: 26. 5.08


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