HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Mueller HJ, Wanner C, Mann J, et al.

Why Guideline Hemoglobin Target Values Cannot Be Met in Dialysis Patients.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:698A 2007

Introduction: Current guidelines recommend haemoglobin (Hb) value to be maintained between 11 and 12 g/dl with no patients above 13 g/dl (K/DOQI) or not more than 15% of patients below Hb of 11 g/dl (EBPG). Mathematically this implies a mean value of 11.5 g/dl with a SD of 0.5 g/dl [1 SD below (15%) and 3 SD above (99.9%) the mean]. The objective of this study was to investigate whether selected German dialysis centres are able to meet these targets.

Methods: We analyzed all Hb values (n=95,490) of 5373 patients from 39 centres (mean 138 pts/centre) enrolled in the AENEAS project (German multicenter pt. database) between 1/2001 and 3/2007. Hb was determined at a high frequency [median interval between two Hb measurements 14 days (1st quartile 12 days, 3rd quartile 28 days)] and the mean difference (delta) of two consecutive measurements of each patient was calculated.

Results: Despite a mean Hb of 11.61.4 g/dl nearly half of the values were out of the recommended range (see figure; 33% were below 11 g/dl and 15% above 13 g/dl). The mean delta (all positive and negative values) was 0.00180.96 g/dl (n=89,685) and the mean absolute delta (without prefix) was 0.680.68 g/dl with 51% of deltas 0.5 g/dl and 22% 1g/dl.

Conclusion: Haemoglobin fluctuations are common and represent a clinical challenge. Even with considerable attention (every other week measurements) K/DOQI and EBPG recommendations cannot be met in a substantial number of patients. Reimbursement strategies, which exclusively are guided by absolute values may need reconsideration.



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