ABSTRACT
BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.
Subject(s)
Humans , Accreditation , Anemia , Anemia, Iron-Deficiency , Calcium , Dialysis , Hemoglobins , Iron , Nephrology , Phosphorus , Pilot Projects , Prevalence , Renal DialysisABSTRACT
BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.
Subject(s)
Humans , Accreditation , Anemia , Anemia, Iron-Deficiency , Calcium , Dialysis , Hemoglobins , Iron , Nephrology , Phosphorus , Pilot Projects , Prevalence , Renal DialysisABSTRACT
PURPOSE: The time average hemoglobin concentration (Hb-Tac) is more likely to represent hemodialysis (HD) patients' true hemoglobin due to variable hemoglobin concentration. This study was performed to evaluate the effect of erythropoietin adjustment on the Hb-Tac according to the Hb of different hemodialysis days. METHODS: A controlled, randomized, cross-over study, where 20 stable hemodialysis patients (7 males, 13 females, mean age 57.8+/-3.0 year, mean HD duration 973+/-707 days) acted as their own controls. EPO adjustment was performed by protocol and according to preHD Hb of the first HD session (group A) or the second HD session (group B) in cross over for each 8 weeks. Serial Hb-tac were calculated by equation [mid week preHD Hb+[midweek pre HT [midweek preHD Hb+(midweek postHD Hb-preHD Hb)/3] every two weeks during the entire study periods. Their iron status were monitored and maintained adequately as K/DOQI guidelines. RESULTS: There was no significant difference in clinical parameters except age during the entire study period. Mean hemoglobin at randomization and after 8, 16 weeks were 10.0+/-0.60, 10.10+/-1.19, 10.1+/-1.03, respectively, in group A compared with 9.93+/-0.62, 9.72+/-1.00, 10.3+/-1.12 g/dL in group B. Mean weekly epoetin alfa dosage at randomization and after 8, 16 weeks were 107.2+/-74.7, 123.2+/-43.1, 123.0+/-85.0 IU/kg/week, respectively in group A compared with 95.4+/-94.7, 107.4+/-60.7, 125.5+/-85.0 IU/kg/week in group B. There were no significant differences in Hb-tac and EPO dosage. Addition of antihypertensive occurred in three patients during EPO adjustment to preHD Hb of the first session. CONCLUSION: EPO dose adjustment according to the different day preHD Hb does not affect the Hb-tac and total EPO.