DOPPS identified 6 guideline-drive, modifiable haemodialysis practices associated with increased mortality risk: catheter access (cf arteriovenous fistula), Kt/V<1.2, serum PO4>5.5mg/dL, serum albumin<3.5g/dL, interdialytic weight gain (IDWG)>5.7%, and Hb<11g/dL. We examined these 6 factors using baseline data from the aggregate sample and the Italian subsample of the MONITOR-CKD5, and compared them against the 2002-03 US DOPPS II results.
MONITOR-CKD5 is a prospective 24-month pharmacoepidemiological study of 2087 CKD5 patients (pts) enrolled with renal anaemia being treated with Binocrit® in 10 European countries which examines the multi-level determinants, predictors and clinical outcomes of biosimilar epoetin alfa in HD pts. Here we report interim results on 312 pts from 21 centers in Italy.
Mean age was 67.8±14.4y, mean time on dialysis was 3.7±5.2y. Most pts were male (62%) and were already being treated with an ESA (85%). Table 1 shows the 6 modifiable risk factors for both the MONITOR-CKD5 aggregate and Italian data vs the 2002-03 US DOPPS II sample (* denotes sample with superior result). Prevalence of 3 of the modifiable risk factors was lower in the Italian MONITOR-CKD5 sample than in the 2002-03 DOPPS II US sample. Rates of low Kt/V and reduced serum albumin were higher in Italy. Anemia was higher in the MONITOR-CKD5 study (both Italian and aggregate sample), however, when adjusted for updated guideline recommendations for Hb levels these rates decreased to half (in the aggregate sample) of the anemia rate in the previous decade in the DOPPS II sample and to three-quarters in the Italian sample.
Management of most the DOPPS-identified modifiable risk factors in HD in Italy and Europe in 2010-12 more often reaches guideline recommendations than in US DOPPS 2002-03; yet there is room for gain. Managing these 6 risk factors to match guideline recommendations can be presumed to decrease mortality and improve patient outcomes.
