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ORIGINAL CONTRIBUTION Comparative Mortality Risk of Anemia Management Practices in Incident Hemodialysis Patients M. Alan Brookhart, PhD Context Controversy exists about optimal management of anemia in end-stage re- Sebastian Schneeweiss, MD, ScD nal disease. Jerry Avorn, MD Objective To compare the mortality risk of different dialysis center–level patterns of anemia management. Brian D. Bradbury, DSc Design, Setting, and Patients Using data from Medicare’s end-stage renal dis- Jun Liu, MD ease program (1999-2007), we characterized each US dialysis center’s annual anemia Wolfgang C. Winkelmayer, MD, ScD management practice by estimating its typical use of erythropoiesis-stimulating agents (ESAs) and intravenous iron in hemodialysis patients within 4 hematocrit categories. PPROPRIATE USE OF ERYTHRO- We used Cox proportional hazards regression to correlate center-level patterns of ESA poiesis-stimulating agents and iron use with 1-year mortality risk in 269 717 incident hemodialysis patients. (ESAs) and intravenous iron Main Outcome Measure One-year all-cause mortality. Acan effectively manage the Results Monthly mortality rates were highest in patients with hematocrit less than 30% anemia of chronic kidney disease and (mortality, 2.1%) and lowest for those with hematocrit of 36% or higher (mortality, 0.7%). 1-3 end-stage renal disease (ESRD), but After adjustment for baseline case-mix differences, dialysis centers that
JAMA – American Medical Association
Published: Mar 3, 2010
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