Original InvestigationDialysis TherapyAdherence to Guidelines for ESRD Anemia Management
Section snippets
Study Design
Data for this study were from a prospective observational study comparing outcomes and costs of care of veterans dialyzing at VA facilities or in the private sector. Patients were enrolled from August 2001 through December 2003. Any patient who had received care at a VA facility within the prior 3 years and was receiving hemodialysis for end-stage renal disease was eligible for enrollment. Patients were excluded if they: (1) had a live kidney donor identified; (2) required skilled nursing
Demographic and Clinical Characteristics of Patient Sample
Demographic and clinical characteristics of patients by facility type are listed in Table 1. Compared with patients dialyzing at private-sector facilities, patients dialyzing at VA facilities were on average younger, more likely to be African American, and less likely to be enrolled in Medicare. Hemoglobin level at baseline for patients dialyzing at VA facilities was lower on average (11.41 versus 12.25 g/dL [114.1 versus 122.5 g/L]). The 36 excluded patients were similar to included subjects
Discussion
We found greater adherence to the clinical practice guideline for subcutaneous route of epoetin administration in VA than private-sector facilities. For 52% of patients receiving regular hemodialysis in VA facilities, subcutaneous was the predominant route of epoetin administration, whereas only 15% of patients in private-sector facilities were administered epoetin predominantly subcutaneously. However, overall adherence to the NKF-KDOQI guideline was low.
Although there is no definitive
Acknowledgment
R. Cxypoliski; N. Pastore; P. Ivanovich, MD; C. Manno; G. Dolson, MD; G. Tasby; R. Agarwal, MD; N. Sachs; G. Shah, MD; C. Molina; A. Mogyorosi, MD; G. Feldman, MD; S. Schmid; D. Sherrard, MD; E. Ayers; C. Stehman-Breen, MD; V. Gandhi, MD; S. Popli, MD; and C. Schneiderman were members of the ESRD Cost Study Group.
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Support: This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (Project no. ECI 20-016). Dr Kaufman receives grants and honoraria from Amgen and Roche. Potential conflicts of interest: None.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
Originally published online as doi:10.1053/j.ajkd.2005.11.012 on February 2, 2006.