%0 Journal Article
%T Association of dialysis facility-level hemoglobin measurement and erythropoiesis-stimulating agent dose adjustment frequencies with dialysis facility-level hemoglobin variation: a retrospective analysis
%A Irfan Khan
%A Mahesh Krishnan
%A Anupam Kothawala
%A Akhtar Ashfaq
%J BMC Nephrology
%D 2011
%I BioMed Central
%R 10.1186/1471-2369-12-22
%X This was a retrospective observational database analysis of patients in dialysis facilities affiliated with large dialysis organizations as of July 01, 2006, covering a follow-up period from July 01, 2006 to June 30, 2009. A total of 2,763 facilities representing 436,442 unique patients were included. The predictors evaluated were facility-level Hb measurement and ESA dose adjustment frequencies, and the outcome measured was facility-level Hb variation.First to 99th percentile ranges for facility-level Hb measurement and ESA dose adjustment frequencies were approximately once per month to once per week and approximately once per 3 months to once per 3 weeks, respectively. Facility-level Hb measurement and ESA dose adjustment frequencies were inversely associated with Hb variation. Modeling results suggested that a more frequent Hb measurement (once per week rather than once per month) was associated with approximately 7% to 9% and 6% to 8% gains in the proportion of patients with Hb levels within a ¡À1 and ¡À2 g/dL range around the mean, respectively. Similarly, more frequent ESA dose adjustment (once per 2 weeks rather than once per 3 months) was associated with approximately 6% to 9% and 5% to 7% gains in the proportion of patients in these respective Hb ranges.Frequent Hb measurements and timely ESA dose adjustments in dialysis patients are associated with lower facility-level Hb variation and an increase in proportion of patients within ¡À1 and ¡À2 g/dL ranges around the facility-level Hb mean.A central aim of anemia management in dialysis patients is to maintain patients' hemoglobin (Hb) levels consistently within a target range. Anemia management guidelines and protocols thus require appropriate adjustment of erythropoiesis-stimulating agent (ESA) doses in response to Hb deviations relative to the target range. There are varied opinions among clinicians, however, regarding practice patterns that help achieve this objective [1-7].The current US Food and Drug Admini
%U http://www.biomedcentral.com/1471-2369/12/22