Hemoglobin Stability and Patient Compliance With Darbepoetin Alfa in Peritoneal Dialysis Patients After the Implementation of the Prospective Payment System |
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| Affiliation: | 1. Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina;2. Amgen Inc, Thousand Oaks, California;3. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina;1. Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan;2. Department of Nursing, Tzu Chi University, Hualien, Taiwan;3. Division of Nephrology, Department of Medicine, Hsin-Jen Hospital, New Taipei County, Taiwan;4. School of Medicine, Tzu Chi University, Hualien, Taiwan;5. Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan;1. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX;2. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;1. Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand;2. Immunology Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;3. Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand;4. Center of Excellence in Immune Diseases and Immune-Mediated Diseases, Chulalongkorn University, Bangkok, Thailand;5. Excellent Center for Organs Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;1. Ochsner Clinic Foundation, New Orleans, Louisiana;3. Optum, Inc, Eden Prairie, Minnesota |
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| Abstract: | PurposeSince the Centers for Medicare & Medicaid Services implemented the End-Stage Renal Disease Prospective Payment System, dialysis providers have increasingly focused on balancing resource utilization and quality outcomes for the treatment of anemia in patients undergoing peritoneal dialysis. Limited data exist regarding anemia management outcomes for these patients in US-based dialysis centers after the implementation of the new payment system.MethodsThis was a retrospective, observational, cohort study of stable PD patients with end-stage renal disease who received darbepoetin alfa for anemia management over a 15-month period (April 1, 2011–June 29, 2012). The medication was administered by staff in the home-training unit instead of being self-administered at home. The primary end point was mean quarterly hemoglobin (Hb) levels. Variability in Hb levels was assessed over the 5 quarters by using repeated measures ANOVA to test for differences in the observed mean SDs.FindingsIn the 139 adult patients on stable peritoneal dialysis and meeting the eligibility criteria, mean (SD) Hb level by quarter was 10.8 (1.2) g/dL in quarters 2 and 3 of 2011, 10.5 (1.1) g/dL in quarter 4 of 2011, and 10.4 (1.1) g/dL in quarters 1 and 2 of 2012. Hb levels were stable (mean SDs, 0.58–0.72) over the 5 quarters of the study. Patient compliance with attendance for all scheduled home training unit visits was 84%.ImplicationsPD patients who underwent darbepoetin alfa administration and twice-monthly laboratory testing in the home-training unit had stable Hb levels. Despite more frequent center visits compared with a home-administered approach, patient compliance was high. |
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| Keywords: | anemia darbepoetin alfa erythropoiesis-stimulating agent hemoglobin peritoneal dialysis |
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