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      Improving the Management of Anemia in Hemodialysis Patients by Implementing the Continuous Quality Improvement Program

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          Abstract

          Background: Anemia is common in hemodialysis patients, and improvement in anemia management is possible with the implementation of continuous quality improvement (CQI) programs. The aim of this study is to improve anemia management in chronic hemodialysis patients using CQI. Methods: Ninety hemodialysis patients in our single center were enrolled in the study. The patients were followed up from January 2004 to October 2005. The CQI team-oriented approach was driven by a process called the ‘FOCUS-PDCA cycle plan’ (find, organize, clarify, uncover, start, plan, do, check and act). Hemoglobin (Hb), serum ferritin and transferrin saturation were monitored periodically. Results: By implementation of the CQI program, the proportion of patients with Hb ≧110 g/l increased from 42.2 to 60.0% (p < 0.05), and the Hb level increased from 101.2 ± 18.05 to 110.4 ± 14.23 g/l (p < 0.0001). The proportion of patients with an adequate iron status increased from 28.0 to 53.3% (p < 0.05). Conclusion: The CQI program is a useful method in the management of anemia in hemodialysis patients.

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          Most cited references 8

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          The Dialysis Outcomes and Practice Patterns Study (DOPPS): An international hemodialysis study

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            Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS).

            Anemia is common in hemodialysis (HD) patients. Data collected from nationally representative samples of HD patients (n = 11,041) in 2002 to 2003 were used to describe current anemia management for long-term HD patients at 309 dialysis units in 12 countries. Analyses of associations and outcomes were adjusted for demographics, 15 comorbid classes, laboratory values, country, and facility clustering. For patients on dialysis therapy for longer than 180 days, 23% to 77% had a hemoglobin (Hgb) concentration less than 11 g/dL ( or =110 g/L) if they were older; were men; had polycystic kidney disease; had greater albumin, transferrin saturation, or calcium levels; were not dialyzing with a catheter; or had lower ferritin levels. Facilities with greater intravenous iron use showed significantly greater facility mean Hgb concentrations. Mean EPO dose varied from 5,297 (Japan) to 17,360 U/wk (United States). Greater country mean EPO doses were significantly associated with greater country mean Hgb concentrations. Several patient characteristics were associated with greater EPO doses. Even in some countries with high intravenous iron use, 35% to 40% of patients had a transferrin saturation less than 20% (below guidelines). These findings indicate large international variations in anemia management, with significant improvements during the last 5 years, although many patients remain below current anemia guidelines, suggesting large and specific opportunities for improvement.
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              Anaemia in haemodialysis patients of five European countries: association with morbidity and mortality in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2006
                April 2006
                27 April 2006
                : 24
                : 3
                : 282-286
                Affiliations
                aRenal Division and Institute of Nephrology, Peking University First Hospital, Beijing, and bRenal Division, Central Hospital of Mianyang, Mianyang, China
                Article
                91304 Blood Purif 2006;24:282–286
                10.1159/000091304
                16462138
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 1, References: 13, Pages: 5
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/91304
                Categories
                Original Paper

                Cardiovascular Medicine, Nephrology

                Renal anemia, Hemodialysis, Continuous quality improvement

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