Beyond traditional in-center hemodialysis, practice patterns are worthy of study among patients who are pre-dialysis or who chose a different modality option. Investigators at the Dialysis Outcomes and Practice Patterns Study group offered a two-hour session during Renal Week that looked at some new research projects in chronic kidney disease care and peritoneal dialysis. The DOPPS symposium was titled “The Dialysis Outcomes and Practice Patterns Study (DOPPS) projects: Novel findings for international hemodialysis practice and new directions.” Talks included:
- Extending the Scope and Reach of the DOPPS Projects, Bruce M. Robinson, MD, FASN
- Trends in US Dialysis: DOPPS Practice Monitor Findings and a Look Ahead, Barry M. Straube, MD
- Identifying Optimal Practice in Advanced CKD: Rationale and Early Findings from CKDopps, Ziad Massy, MD, PhD
- PDOPPS: Unifying Efforts to Improve Outcomes in Peritoneal Dialysis, Simon J. Davies, MD
- Improving Patient-Centered Outcomes in Hemodialysis: What Are the Next Steps? Francesca Tentori, MD
- Treatment of Mineral and Bone Disorder: Recent Trends and Outcomes, David C. Mendelssohn, MD
Speaker Barry Staube, the former chief medical officer for the Centers for Medicare & Medicaid Services, offered a summary of DOPPS data on in-center hemodialysis care, particularly on the drop in the use of anemia drugs and the subsequent rise in the use of iron drugs to help maintain hemoglobins. While use of erythropoiesis-stimulating drugs has dropped by 31% since the ESRD payment bundle took affect, doses in Europe and Japan have risen by about 10%. Hemoglobins in Japan average around 10.6%, Straube noted, but for the first time, hemoglobin levels in the U.S. were lower than the levels in Europe.
With the drop in ESA use has come a rise in IV iron—up 10% since the onset of the bundle. Ferritin levels have also jumped significantly in the United States. From August 2010 through August 2012, median serum ferritin levels increased 40% to 795 ng/ml, with 15% of patients having ferritin levels >1,200 ng/mL. During the same time, median transferrin saturation (TSAT) levels increased from 28% to 29%, while the proportion of patients with TSAT <20% fell from 20% to 18%. In Europe, 466 ng/ml is a more likely median level for serum ferritin, and in Japan around 166 mg/nl. Likewise, a notable increase in transfusions “is a concern,” said Straube.
In tracking new research in CKD and peritoneal dialysis, DOPPS has enlisted countries like Brazil, Germany, France, and the United States (will be part of future research). Sampling will be done in 40-60 clinics in the U.S., 50 in Germany, 46 in France, and 22 clinics in Brazil for the CKD project. Patients are in Stage 3-4 CKD, with follow-up of three years (five years in France). Researchers will look at optimal timing for a dialysis start, and improvements in early access interventions.
PDOPPS will involve patients in Japan, Australia, Canada, and the U.S. as well, with a close look at all cause PD technique failure. “We now know that survival on PD has improved considerably, but techniques failure has not,” noted chief PDOPPS investigator Simon Davies, MD.