Chapter 9: Haemoglobin, ferritin and erythropoietin amongst UK adult dialysis patients in 2009: National and centre-specific analyses

Abstract

Background: The UK Renal Association (RA) and National Institute for Health and Clinical Excellence (NICE) have published Clinical Practice Guidelines which include recommendations for management of anaemia in established renal failure. Aims: To determine the extent to which the guidelines for anaemia management are met in the UK. Methods: Quarterly data were obtained regarding haemoglobin (Hb) and factors that influence Hb from renal centres in England, Wales, Northern Ireland (EWNI) and the Scottish Renal Registry for the incident and prevalent renal replacement therapy (RRT) cohorts for 2009. Results: In the UK, in 2009 55% of patients commenced dialysis therapy with Hb ≥10.0 g/dl (median Hb 10.2 g/dl). The median Hb of haemodialysis (HD) patients was 11.6 g/dl with an interquartile range (IQR) of 10.6 - 12.4 g/dl. Of HD patients 85% had Hb ≥10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.7 g/dl (IQR 10.7-12.6 g/dl). Of UK PD patients, 88% had Hb ≥10.0 g/dl. The median ferritin in HD patients in EWNI was 441 μg/L (IQR 289-629) and 96% of HD patients had a ferritin ≥100 μg/L. The median ferritin in PD patients was 249 μg/L (IQR 142-412) with 86% of PD patients having a ferritin ≥100 μg/L. In EWNI the mean Erythropoietin Stimulating Agent (ESA) dose was higher for HD than PD patients (9,507 vs. 6,212 IU/week). Conclusions: In 2009, 56% of prevalent HD patients had a Hb ≥10.5 and ≤12.5 g/dl compared with 54% in 2008 and 53% in 2007. Fifty-four percent of prevalent PD patients had a Hb ≥10.5 and ≤12.5 g/dl compared to 55% in 2008. Copyright © 2011 S. Karger AG, Basel.