Researchers from the Dialysis Outcomes and Practice Patterns Study (DOPPS) released a fresh batch of data––through April of this year––from its Practice Monitor yesterday, showing that while adequacy and hemoglobins have stabilized, ferritin levels may be a cause for concern.
The Practice Monitor is based on a sample of 3,200 to 4,000 hemodialysis patients in approximately 100 to 120 US clinics. Data was presented during a hour-long web conference moderated by Nephrology News & Issues.
Notable trends in HD practices in the US DOPPS sample from August 2010 to April 2014 include:
As of April 2011, the mean hemoglobin level from patients in the DOPPS sampling was 11.36; data through April 2014 show that mean Hgb levels have continued to decline gradually, to 10.83 g/dL. The percentage of ESA-treated patients with Hgb >12 g/dL has declined substantially, from 26% to 8%, while the percentage with Hgb <10 g/dL has increased from 9% to 21%.
Since August 2010, mean prescribed IV epoetin dose has decreased by 38% and the average administered IV epoetin dose has decreased by 42%; however, doses have remained relatively stable in the past year. The decline in administered dose is greater than that for prescribed dose because doses are now withheld more frequently.
The DOPPS has followed international trends for over a decade, and 2012 was the first year that mean Hgb levels were lower in the US than in Europe, Canada, and Australia/New Zealand. Median prescribed epoetin doses in the US are now generally similar to these other countries.
Iron and ferritin
Serum ferritin levels increased dramatically from 2010 to 2012 and have remained high. In April 2014, mean ferritin was 799 ng/ml, and >75% of patients had ferritin above 500 ng/ml. While the number of patients receiving iron has remained relatively stable, prescribed IV iron dosing has gone from 802 milligrams/month in August 2010 to 914 milligrams in the latest sampling of DOPPS facilities (reflects 90th percentile of prescribed doses). By comparison, the median IV iron dose in the same period ranged from 204 mg/mo to 195 mg/mo, and the mean IV iron dose ranged from 337 mg/mo to 390 mg/mo.
Mean ferritin levels are the highest compared to Europe and Japan.
Mineral and bone disorder
Mean parathyroid hormone (PTH) levels increased by >30% in 2011 and have been stable since. According to the DOPPS data, 30% of black patients and 15% of non-black patients had PTH above 600 pg/ml in April 2014.
Among patients treated with an active vitamin D analog, the proportion receiving doxercalciferol has increased from 13% to 92% since August 2010, according to the DOPPS sampling. This transition is primarily due to changes by the large dialysis organizations.
Dialysis treatment measures
The Medicare End-Stage Renal Disease Quality Incentive Payment (ESRD QIP) program links reimbursement to URR ≥65%; this will change to Kt/V ≥1.2 in the 2015 payment year. Among patients on HD for more than a year, the percent with URR ≥65% increased from 92% to 96% in the DOPPS sampling; the percent with single pool Kt/V ≥1.2 increased from 93% to 96%.
To learn more about the Practice Monitor and the data it collects, visit www.DOPPS.org/DPM.