Anemia Management in the China Dialysis Outcomes and Practice Patterns Study (DOPPS)

As more and more patients with end-stage renal disease in China are able to access hemodialysis, it is important to study the management of accompanying anemia. Researchers examined China Dialysis Outcomes and Practice Patterns Study (DOPPS) data gathered from 1,379 patients at 45 hemodialysis units in three major metropolitan cities in China. They found that a substantial proportion of hemodialysis patients in the China DOPPS do not meet hemoglobin (Hgb) targets as expressed by a majority of facility medical directors (i.e., ≥ 11 g/dL). Twenty-one percent of China DOPPS patients had Hgb < 9 g/dL compared with approximately ten percent or less in Japan and North America.

DOPPS researchers identified several unique factors that may partially explain this gap between expressed target and achieved Hgb. The majority of China DOPPS patients do not have full insurance coverage, and for those that do, a stipulated reimbursement cap may limit the use of erythropoietin stimulating agent (ESA), which is used to treat anemia.

Dr. Shuchi Anand , who co-authored the study, commented, “Close to one in five patients on hemodialysis in the China DOPPS study was anemic, although nearly everyone was receiving a domestically manufactured ESA. This implies that evaluating the efficacy of domestically manufactured ESA and dose titration is a crucial step towards improving anemia management in China. Use of oral and intravenous iron to optimize ESA response also requires further study.”

Twice-weekly hemodialysis is also more commonly practiced in China than in other DOPPS countries, where three-times weekly hemodialysis is the norm. Combined with patient financial contribution to therapy and a lack of substantial increase in ESA dose at lower Hgb concentrations, this may contribute to the gap between expressed target and achieved Hgb in the China DOPPS.

CITATION: Zuo L, Wang M, Hou FF, Yan Y, Chen N, Qian J, Wang M, Bieber B, Pisoni RL, Robinson BM, Anand S. Anemia Management in the China Dialysis Outcomes and Practice Patterns Study. Blood Purif. 2016 Mar 31;42(1):33-43. DOI:10.1159/000442741.

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April 7, 2016

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