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

Eric W. Young, David A Goodkin, Donna Mapes … (2000)

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

Friedrich Port, Tadao Akizawa, José Cruz … (2004)

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)

R. L. Pisoni, C Combe, J Bommer … (2004)

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Author and article information

Journal

Journal ID (publisher-id): BPU

Journal ID (nlm-ta): Blood Purif

Journal ID (doi): 10.1159/issn.0253-5068

Title: Blood Purification

Publisher: S. Karger AG

ISSN (Print): 0253-5068

ISSN (Electronic): 1421-9735

Publication date Subscription-year: 2006

Publication date (Print): April 2006

Publication date (Electronic): 27 April 2006

Volume: 24

Issue: 3

Pages: 282-286

Affiliations

^aRenal Division and Institute of Nephrology, Peking University First Hospital, Beijing, and ^bRenal Division, Central Hospital of Mianyang, Mianyang, China

Article

Publisher ID: 91304 Other ID: Blood Purif 2006;24:282–286

DOI: 10.1159/000091304

PubMed ID: 16462138

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