In a packed room at the American Society of Nephrology’s Kidney Week, the Dialysis Outcomes and Practice Patterns Study group presented sobering, but expected, data on 140 U.S. dialysis facilities and more than 5,000 dialysis patients.
The ESRD bundle, anemia treatment, and hemoglobin levels
Since the bundle, hemoglobin levels have dropped “dramatically,” and according to Bruce M. Robinson, MD, FASN, they might still be dropping. Sixteen percent of dialysis patients now have Hgb levels less than 10, and 4% are less than nine. EPO doses were higher before the bundle in large dialysis organizations and have dropped the most substantially in those providers. Intravenous iron use rose 20% since the bundle and there is new evidence that high IV iron may be associated with poor outcomes, said Sylvia Paz B. Ramirez, MD. There has been a 23% rise in monthly transfusion rates between November 2010 and November 2011.
Other data from U.S. dialysis clinics
Parathyroid levels have been rising since the bundle, and they are at levels substantially higher in the United States than in other DOPPS countries. Mortality and hospitalizations rates in the United States have been steady for the last couple of years and are highest in the United States, said Friedrich K. Port, MD.
Studying cardiovascular risks in dialysis patients
David A. Goodkin, MD, FASN, spoke about cardiovascular risk factors and said that recent evidence shows that low blood pressure can predispose a patient to myocardial problems during dialysis. He questioned whether it is wise to try to get all dialysis patients to a BP below 140. He showed slides from a U.K. study that performed PET scans during dialysis treatments and showed that myocardial blood flow reduced significantly, with only partial restoration afterwards. These scans were not done on dialysis patients with heart problems, Goodkin noted. He mentioned the need for randomized control trials to investigate these issues, and noted that nephrology lags behind all other specialties in the number of clinical trials conducted.